Managing your diet on basal-bolus insulin

Your need for insulin has been explained by the Diabetes team, who are happy to answer any questions you have.

You have been prescribed two different kinds of insulin.

One is a background or “basal” insulin, which works steadily over 24 hours.

The basal insulin (e.g. Abasaglar, Lantus, Tresiba, Toujeo) should be taken at the same time every day. Your Diabetes Specialist Nurse will have advised you on how to increase or decrease the dose gradually in order to get the dose right for you. The dose is then usually the same every day.

The second type of insulin is a mealtime or “bolus” insulin and is quick-acting, it lasts for around 4 hours.

Your mealtime quick-acting insulin (e.g. Fiasp, Apidra, Humalog, NovoRapid, Trurapi) should be taken 10 to
15 minutes before each meal that contains carbohydrate. It stops the blood glucose level from going too high after eating and helps your body to use the glucose from carbohydrates as energy.

The Diabetes team may advise you to take the same dose with your meals each day, or may tell you to vary the dose depending on how much carbohydrate is in the meal.

Your dietitian can give you individual advice on this.

Which foods contain carbohydrate?

A healthy diet consists of food groups as shown on the Eatwell Guide. Some foods within each group contain carbohydrate. Examples are highlighted below.

Food and your blood glucose level

• All carbohydrate (not just sweet or sugary food) is broken down into glucose. Insulin helps your body use the glucose for energy.
• Carbohydrates are the only foods that have a direct affect on your blood glucose.
• Protein and fat (uncoated meat, fish, eggs, cheese, butter, margarine) do not affect blood glucose levels.
• Vegetables, beans, pulses and nuts have very little affect on your blood glucose levels.

The following tips can help you keep your blood glucose levels within your target range

1. Avoid sugary drinks such as full sugar pop, milkshakes, smoothies, sugar or honey in tea and coffee. Limit fresh fruit juice to one 150 ml glass per day, always with a meal and never on an empty stomach. Instead, try diet or no added sugar drinks or an artificial sweetener for hot drinks.
2. If you miss a meal, do not take mealtime insulin at that mealtime. If you have a meal with no carbohydrate or very little carbohydrate e.g. omelette and salad or just meat and vegetables, do not take mealtime insulin with that meal.
3. At first, try to have similar amounts of carbohydrate as part of your meals day to day; for example:
   
   • potatoes – 4 new or small (egg size) potatoes (200 g cooked weight);
   • bread – 2 slices medium thickness;
   • chapatti / wrap / injira – 1 small / medium (size of a dinner plate);
   • pitta – medium (70 g);
   • rice / cous cous – 4 tablespoons of cooked (160 g cooked weight);
   • pasta / noodles – 4 tablespoons of cooked (145 g cooked weight); and
   • yam / plantain / fufu – fist size – (100 g cooked weight).
4. If you have an extra meal, you may need some mealtime insulin with it. Please discuss this with your Diabetes team.
5. If you are more active than usual, you may need a small carbohydrate snack between meals e.g. a portion (handful) of fruit or a small glass of milk.
6. Drinking alcohol will affect your blood glucose levels.
7. If you are getting 2 to 3 hypos in a week (blood glucose level below 4 mmol/l) despite following the above advice, you may need to reduce your insulin doses. The Diabetes team can advise you on this.

Next steps

What is Carbohydrate Counting?

By working out how much carbohydrate is in the meal or snack you are going to have, you can give the right insulin dose to match this. This allows you to be more flexible with what you eat, drink and when.

Your dietitian can work with you to:

• become confident in carbohydrate counting and ways to make this easier. You may find it helpful to use measuring cups or spoons, or weigh out food;
• use a food and blood glucose diary to help you work out your individual insulin requirements; and
• check your background insulin dose is right for you.

Resources

Diabetes UK website – www.diabetes.org.uk

NHS Website – https://www.nhs.uk/conditions/diabetes

‘Carbs and Cals’ as a smartphone app or book, by Chris Cheyette and Yello Balolia.