Key Terms

Before we begin, it’s important to understand Glycemic Index and Glycemic Load, and how they impact your blood sugar (BG).

Glycemic Index (GI): The Glycemic Index (GI) ranks carbohydrates on a scale of 0-100 based on how much they raise blood sugar levels after eating, which is determined by how rapidly they are digested and absorbed.  The higher the GI, the more rapidly the carbohydrate is digested and absorbed and therefore, the more quickly it raises your blood sugar levels.¹

Low GI – 55 or less

Medium GI – 56 – 69

Hi GI – 70 or higher

Glycemic Load (GL): The glycemic load (GL) is a way to assess the impact of carbohydrates related to the glycemic index of the food being consumed on your blood sugar levels and gives a fuller picture than does glycemic index alone. A GI value tells you only how rapidly a particular carbohydrate turns into sugar, but it doesn’t tell you how much of that carbohydrate is in a serving of a particular food. You need to know both things to understand a food’s effect on blood sugar. That is where glycemic load comes in. The carbohydrate in watermelon, for example, has a high GI, but there aren’t many carbs per serving, so watermelon’s glycemic load is relatively low.

Low GL – 10 or less

Medium GL – 11 to 19 inclusive

High GL – 20 or more

Foods that have a low GL almost always have a low GI. Foods with an intermediate or high GL range from very low to very high GI.

Know Your Carbs to Insulin Ratio

It’s very important to know what your baseline carbohydrates (in grams) per unit of insulin ratio is (we’ll call this your carbs to insulin ratio) so you can be as effective as possible in managing your blood glucose levels.

Let’s consider your carbs to insulin ratio is typically 10:1; that is, for every 10 grams of carbohydrates you eat, you will need 1 unit of insulin to “consume” it properly and keep your blood glucose (BG) within a normal range. Let’s take a look at how your day might unfold, beginning with breakfast:

A carbs/insulin ration of 10:1 means you would need 6.5 units of fast acting insulin (i.e. Humalog) to properly use the 65 grams of carbohydrates you will have for breakfast. But that’s only a part of the story. Here are a few important considerations:

• Generally speaking, with fast acting insulins, peak insulin levels in your body occur approx. 30-90 minutes after dosing so you can expect a similar time frame for your dosing to have its peak impact on blood glucose levels. The impact will trail off significantly after 2 hours. (Note: This is from the insert that comes with my Humalog.)
• There are all kinds of factors that affect this; it varies by individual, injection site, exercise and other factors, so test often and know your unique relationship with insulin and BG levels.
• Considering this, I would shoot up (dose) approx. 20 min ahead of time, considering the glycemic index of all these foods is fairly high.

Day-To-Day Nutrition

A big challenge for diabetics is managing the relationship between weight, exercise, food and insulin. If you already have good eating habits, the challenge won’t be so demanding.

To start off, keep a diary of everything you eat….for a week. This will need to include what, how much and when. When you eat at home, calculate from the packages; when you eat out, many restaurants list nutrition facts on their menu, either in the restaurant or online. There are also apps that provide excellent detail for a broad listing of foods. The app I prefer is MyFitnessPal, which can also act as your diary. For the most part you will likely find that you eat a lot of the same things, which will make it easier to track what you eat.

From this data you can determine that critical relationship between what you eat, insulin and resulting BG.

If your eating habits aren’t so good…you will see it here in your diary and be able to make adjustments, as necessary, with your food, medication, exercise or a combination of all. We will show you how to do this in our Management Tools section. But, generally speaking, we need to remember there is a direct correlation between insulin and your weight. If your BG is typically high and you’re maintaining your weight, well…if you eat the same and begin increasing your insulin to get your BG down, you will gain weight. So, you may need to change what and how much you’re eating to maintain your current weight. If you’re overweight and your BG has been high, you’re going to need to change your eating habits AND reduce your insulin to get to your desired weight and BG levels. There are a variety of scenarios but you can basically see how it works.