Information for children and their parents/carers
Diabetes Home Care – multiple daily injections, also
called Basal Bolus Regime
This leaflet aims to answer any questions you may have about your/your child’s
diabetes home care. If there is anything you don’t understand or if you have any
questions, please ask your nurse.
What is the basal bolus regime?
Basal bolus regime allows you to match your insulin with what you eat. Two different types of
insulin used:
1. The basal or background insulin is a long acting insulin called Glargine (also known as
Lantus). In some children Levemir is used instead of Glargine.
This is a single injection once a day and lasts about 24 hours with no peaks or troughs in
its action. It provides a background amount of insulin that your body needs unrelated to
food intake. It needs to be given at the same time each day usually in the evening but in
very young children it is given in the morning.
The dose is changed to achieve blood glucose levels in the morning before breakfast
between 4 to 8mmol/l
2. The bolus insulin is a fast-acting insulin called Novorapid. In some children Humalog is
used instead of Novorapid
This insulin starts to work within 10 minutes and lasts for 2-3 hours and so is used to
provide the insulin required for carbohydrate intake at meal and snack times. You will
need to have this insulin just before eating any meal or large snack containing
carbohydrate but the time you eat is up to you. The diabetes team will show you how to
match the Novorapid (or Humalog) dose to amount of carbohydrate eaten.
Blood glucose levels must be taken and recorded in your diary before eating and giving
insulin in order to give the correct dose of insulin each time.
What are the benefits of the basal bolus regime?
The basal bolus regime enables you to adjust your fast acting insulin during the day
depending on the type and quantity of food being eaten.
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Benefits of basal bolus are:
 Targets insulin to food intake.
 Allows flexibility of meal times.
 You can change portion size to appetite.
 Reduces the risk of low blood sugars.
 Allows correction of high or low blood sugar levels.
 When used properly, can help to improve overall blood glucose control.
What food should I eat?
Children and young people with diabetes should have a healthy balanced diet rich in fruit,
vegetables and starchy foods which provides the energy and nutrients they need to grow.
They need the same amount of energy and nutrients as all other children and young people.
Type 1 diabetes means that your body cannot produce insulin. In the past, your body
produced insulin every time you ate carbohydrate. Insulin takes the glucose that comes into
your blood stream from the carbohydrate foods you eat, into the cells where it is needed for
energy, leaving just the right amount of glucose in your blood. Now you need to inject insulin.
Insulin you take with each meal allows your body to use the glucose from the carbohydrate
food.
This injected insulin has to be balanced with the carbohydrate foods you eat so you can use
glucose for energy as you did before and keep your blood glucose level as near normal as
possible.
What is carbohydrate?
All carbohydrate foods are broken down to glucose which is then absorbed into the
bloodstream. The insulin you take with each meal allows your body to use the glucose from
the carbohydrate food.
Carbohydrate foods are either starchy or sugary.
Starchy carbohydrate foods are:
 Breakfast cereals
 Porridge or Ready Brek
 Bread of all types including white, wholemeal, pitta, naan etc
 Crumpets and toasting muffins
 Breads and scones including dried fruit e.g.
teacakes,
 Pasta
 Rice
 Potato cooked in any way e.g. mashed, roast, chipped, jacket.
 Baked beans
 Plain biscuits such crackers, digestive, hobnob or rich tea
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Always include some starchy carbohydrate food at each meal because the glucose is
released from these foods slowly
Sugary carbohydrate foods should only be eaten with meals. Glucose is released from these
foods more quickly. Eating them as part of a meal will slow down the rate at which the
glucose from these foods can enter the bloodstream.
Sugary carbohydrate foods are:
 Sweet breakfast cereals e.g. Frosties, Sugar puffs, Ricicles etc.
 Jams, honey and marmalade.
 Sweet biscuits including those with jam, cream or chocolate.
 Chocolate coated biscuits
 Sweet cakes and pastries
 Desserts such as mousses, ice cream yoghurts
 Sweets and chocolate.
 Dried fruit e.g. raisins
What should I eat for a snack?
Young children may need snacks in between meals and before bed, particularly if they are
very active, in order to meet their energy needs. Snacks should be small and based on
starchy foods such as bread, cereal bars, plain biscuits or fresh fruit. The main carbohydrate
in fruit is a natural sugar called fructose. Fruit also contains fibre which slows down the
release of the natural sugar from the fruit so it can be eaten with meals or as a snack.
Small snack ideas
 One portion of fresh fruit e.g.; an apple, banana, pear, orange. or
 Oat based cereal bars e.g.; Quaker Chewee, Tracker bars. or
 A slice of toast. or
 A glass of milk (200ml). or
 A standard packet of crisps – any type, only one packet per day. or
 A plain biscuit e.g. digestive, hob nob or rich tea.
Larger snacks
If you need larger snacks such as two or more slices of toast, a sandwich, a toasted teacake,
or a large bowl of cereal you are likely to need additional insulin.
What should I drink?
Water, low calorie/no added sugar fruit squashes and diet fizzy drinks are all suitable to drink
at any time. Fresh fruit juices contain a lot of natural sugar so drink them occasionally, in
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small amounts, with a meal. Milk contains carbohydrate and should only be taken as part of
a meal or snack.
How do I carbohydrate count?
The type of carbohydrate (starchy OR sugary) will effect how quickly the blood glucose level
changes following a meal or snack.
Remember to keep high fat foods to occasional treats.
What if I want a snack?
A healthy snack between meals is fine but it should be less than 10 grammes of
carbohydrate, any more than that and you will need an insulin injection.
The total amount of carbohydrate (starchy AND sugary) you eat at each meal or snack will
effect what your blood glucose level is following that meal or snack.
Matching the amount of insulin you take for a meal or large snack with the total amount of
carbohydrate it contains allows you to vary the amount and type of food you eat whilst
keeping your blood glucose levels in the target range of 4 – 8 mmol/l.
The amount of Novorapid (or Humalog) you should give for a meal or large snack depends
on your insulin to carbohydrate ratio and will be decided by the diabetes team. The
carbohydrate values of individual foods are given in grams.
Your insulin to carbohydrate ratio is:
____ Unit/s Novorapid (or Humalog) insulin for every 10g carbohydrate eaten
How do I find out how much carbohydrate is in food?
You can work out how much carbohydrate there is in a meal or snack by using the following
sources of information:
Carbohydrate food list –which will be given to you by the diabetes team. This lists the
approximate number of grams of carbohydrate there are in individual foods. You will find it
useful to weigh the amount of some foods you eat such as pasta or rice so you know exactly
how much carbohydrate there is in your portion of that food.
Carbohydrate counting books – these list the carbohydrate values of common foods, fast
foods, ready meals etc.
 Collins Gem series, Carb counter ISBN 978-0-00-717601-4
The Fat, Fibre and Carbohydrate Counter; Editor Dell Stanford; ISBN 0-00-717601-5
 Carbs and Cals, A visual guide to carbohydrate counting and calorie counting for people
with diabetes. Chris Cheyette and Yello Balolia. ISBN 978-0-9564430-0-7
Food labels – the nutrition information on food packets details the carbohydrate content of
that particular food.
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Using food labels
Some labels will give you the amount of carbohydrate per item e.g.; per bar, some will just
give the amount per 100g of the product.
Example 1: Harvest Chewee Milk Choc Chip Cereal bar(details per bar).
Typical values
Per 100g
Per 22g bar
Energy
1800Kj/427 Kcal
395Kj/ 94Kcal
Protein
5.0g
1.1g
Carbohydrate
68.0g
15.0g
Of which sugars
27.0g
5.9g
Fat
15.0g
3.3g
Of which saturates
9.5g
2.1g
Example 2: Shreddies (details per 100g).
Typical values:
Per 100g
Energy
1485 Kj/350 kcal
Protein
9.9g
Carbohydrate
73.4g
Of which: sugars
15.5g
Fat
1.9g
Of which: saturates
0.4g
Calculating from the amount per 100g
Use the total Carbohydrate not ‘of which: sugars’ i.e. 73g.
Weigh the amount of Shreddies you are going to eat e.g. 40g
To calculate how much carbohydrate there is in 40g of Shreddies, divide 73 by 100 = 0.73g
(this is how much there is in 1g of Shreddies).
Then multiply 0.73 by 40 = 29.2 (this is how much there is in 40g of Shreddies).
So: 40g of Shreddies have approx 30g carbohydrate
How do I calculate the total amount of carbohydrate in a meal or snack?
While you are growing, snacks may be necessary. Remember for some older children
snacking can make maintaining or losing weight more difficult.
You will need to add all the carbohydrate (CHO) values of each food eaten together.
For example: Breakfast
40g Shreddies contain
30g CHO
Milk on cereal (175mls) contains
10g CHO
1 slice thick bread, toasted contains
20g CHO
Total
60g CHO
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Packed lunch
2 slices bread (15g carbohydrate slice) 30g CHO
Ham and tomato filling
no carbohydrate
Packet crisps
12g CHO
Apple
15g CHO
Cereal bar
15g CHO
Total
72g CHO
Evening meal
Spaghetti Bolognese.
200g cooked spaghetti
50g CHO
Bolognese sauce (meat and tomato)
no CHO
Side salad
no CHO
Carton of fruit yoghurt
15g CHO
Total
65g CHO
How much Novorapid (or Humalog) do I give?
This will depend on your insulin to carbohydrate ratio, but, for example:
If you are using 1 unit for 10g carbohydrate you would give 6 units of Novorapid (or
Humalog) for 60g of carbohydrate.
What if the amount of carbohydrate in the meal is not exactly 60g (or another
multiple of 10)?
After you have added up the total carbohydrate in the meal, you will round up or down to the
nearest 10.
For example:
If the total is between 55 - 59g you would round up to 60g.
If the total is 51 - 54g you would round down to 50g.
When do I give the Novorapid (or Humalog)?
It is important to give the Novorapid ( or Humalog) as close to the meal as possible to get the
best match between the insulin and the rise in blood glucose level.
Ideally, this means giving the insulin immediately before the meal but occasionally this may
not be practical so:
Give the Novorapid (or Humalog) immediately before the meal:
Often meals out are larger than at home especially if you are having more than one course.
If you know how much carbohydrate you are going to eat you can work out the amount of
Novorapid you need and give it immediately before you eat.
OR
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Give the Novorapid (or Humalog) between courses:
Once you have finished your main course you can then decide if you are going to have a
dessert. If so, add the amount of Novorapid (or Humalog) needed for the dessert to how
much you need for the main course and give it before you eat the dessert. The Novorapid (or
Humalog) must be given within half an hour of the start of the meal.
OR
Give the Novorapid (or Humalog) immediately after the meal:
If you are not sure how much you are going to eat, or may change your mind during the
meal, for example when eating out, work out the amount of Nov rapid (or Humalog) needed
for the meal after you have finished eating and give it immediately after the meal. This
should be within half an hour of the start of the meal.
Was the dose of Novorapid (or Humalog) correct?
Testing your blood glucose level just before your meal and again approximately 3 hours later
will tell you if you gave the correct amount of insulin for the carbohydrate in your meal.
The carbohydrate content (starch v sugar) may be different and so it may be important to
consider this when assessing the level. If you would like more information or help, please
talk to a diabetes dietitian on telephone number: 0118 322 6578. If the blood glucose level is
in between 4 – 8 mmol before the meal, it will be between 4- 8 mmol again 3 hours after the
meal if the correct amount of Novorapid (or Humalog) was given for the meal.
If the after-meal blood glucose reading is much higher than the before- meal reading then
you have not given enough insulin.
If the after-meal blood glucose level is much lower than the before-meal reading then you
have had too much insulin.
What about eating out?
As this regime allows your meals to be more flexible then eating out should not be a
problem.
With practice estimating the amount of carbohydrate content of a meal will become easier.
Most restaurants have the nutritional value of their food on the internet and this can be a
good source to find out the information before you go out.
Most people eat similar foods when out so once you have eaten it once you will know what
to do next time.
Who can I speak to if I am worried or have any questions?
We hope that this information leaflet will help you to understand all about your treatment.
We have tried to make it clear as possible but some medical information can be difficult to
understand. If you would like more information or help, please talk to a diabetes dietitian on
telephone number: 0118 322 6578 or paediatric diabetes nurse on telephone number: 0118
322 8922.
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Further information
Diabetes UK www.diabetes.org.uk/
Reminder of useful numbers
Diabetes Dietitian
0118 322 6578
Paediatric Diabetes Nurse
0118 322 8922
This document can be made available in other languages and formats upon
request.
Royal Berkshire NHS Foundation Trust
London Road
Reading RG1 5AN
Telephone 0118 322 5111
www.royalberkshire.nhs.uk
PAED_338
Jo Spinks, Kay Grint, August 2015
Revised May 2011. Review due: August 2017
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