# To bolus or not to bolus, that is the question

Okay, so I have been trying to figure this one out for a while… What is the deal with “net” carbs. A lot of these low carb foods say only 3 net grams, but the back says it has 19grams of carbs… Do you bolus a full 19grams worth for these foods? A good example is some of the atkins foods.

What do you do?

I went over this a while ago with my nutritionist and CDE. I the answer was that you bolus as normal for the 3 grams of carbs and then you bolus for 2/3 of the rest of the carbs. So in equation form:

“normal bolus for net carbs” + (“total carbs” - “net carbs”) * (2/3) * “normal bolus for 1g of carbs”

“normal bolus for 3g carbs” + (19-3) * (2/3) * “normal bolus for 1g of carbs”

Of course this is one of those “Your Diabetes May Vary” type things so you’ll have to finagle it a bit to work for you, I normally just decide that it’s close enough to my normal bolus to bolus for all the carbs but find a method that works for you.

I haven’t tried that. I bolus for all the carbs. I tried bolusing for net carbs once and spiked way higher than I anticipated.

Check and see how many grams there are of Fiber and Sugar Alcohols. Add these two numbers together and divide the total by two. Now subtract that from the total number of carbs. It should be less than the 19… but now quite as low as 3. Hope that helps!

I always bolus for the full carb content, I totally ignore the “net carbs” or “good vs. bad carbs” propaganda. The main reasons are:
a) I was diabetes-educated over 20 years ago, so my thinking is still “old school” and that is, a carb is a carb and they all end up as glucose eventually.
b) there is no FDA regulation of terms like “net carbs” or “good carbs” so the product makers can take liberties with that labeling. On the other hand, the standard nutritional information labels are regulated and must be accurate (unless the FDA is asleep on the job), so I trust them a lot more.

I’ve never found a low “net carb” food to make any difference, and I always bolus for the total carb content listed on the nutritional information panel. Oh, and I ignore Sugar Alcohol info, too as it doesn’t seem to matter for me.
As Rebecca says, YBMV (You Body May Vary).

I hate to say this, but I think all of this made me more confused…

Amen to your letter a). I, too, was taught to do the old school style and it has always worked for me.

Try this then. Pick a food for which you know the carb count, the fiber, the sugar alcohol, etc. Try to eat them bolusing for them in different ways when your bg is in range. Then test an hour after and see what the outcome was. Whatever works for you is what you should try.

Yeah, I often forget about the fiber issue because most foods don’t have enough to make a difference (I think 5g per serving is the minimum recommended amount to use it in calculations). I don’t eat beans very often

I had a nutrition class today with a CDE. She gave me a handout which I believe was either from ADA or followed ADA guidelines. On the handout the rule is the same for both fiber and sugar alcohols. If the food has 5 grams or greater of fiber or sugar alcohols, subtract half the grams of the one (or both) that is greater than or equal to 5 grams from the total carbohydates. Here is an example:

From the label:
Total carbohydate 24g
Dietary fiber 5g
Sugars 5g
Other carbohydates 14g

Carbohydrates to count:
Total carbohydrates 24g
Dietary fiber -2.5g
21.5 available carbohydrate

I haven’t tried this adjustment yet, so I don’t know if it works for me.