Managing meals - a guide for multiple daily injections (MDI)

This information is for children and young people with type 1 diabetes who use multiple daily injections.  

Top tips for managing mealtimes using multiple daily injections

  Have a meal routine and remember healthy eating

Aim for 3 meals per day with only 1-2 small snacks throughout the day if needed.   

Try and leave a gap of at least 2 hours in between eating during the day. Try not to eat overnight. Having a balanced meal pattern with a period overnight without food is important for a healthy body weight. Leaving 2-3 hours between food also allows your glucose to return into range.  

Having a healthy, varied diet with plenty of wholegrains, fruit, vegetables, beans and pulses helps with diabetes management.  

Try to limit processed foods as these tend to be higher in refined sugar and less healthy fats.  

 Count your carbohydrates

We know that young people tend to be good at counting carbohydrates. Think about what part of the meal is carbohydrate and use the Carbs & Cals book or app to count the amount of carbohydrate you are going to eat.  

Try to be as accurate as possible.  

It is a good idea to recheck the carb count of the foods you eat regularly. As you grow your portions sizes will change. It is important to make sure your carb counts are up to date!  

 Inject before eating

This helps to reduce the glucose spike you might see after eating.    

• If you use a rapid acting insulin (Novorapid, Humalog, Apidra) try to inject 15-20 minutes before eating.  
• If you use an ultra-rapid acting insulin (Fiasp, Lyumjev) try to inject 5 minutes before eating.  

For meals that contain high glycaemic index foods such as breakfast cereal, you might need to inject earlier to reduce the post meal spike.  

Doing this will help you spend more time in range.

 Use a bolus calculator

We suggest using the MyLife bolus calculator app. It uses your insulin to carbohydrate ratio, correction factor, glucose target and current glucose reading to calculate how much insulin you need for a meal.  

A bolus calculator also remembers any previous insulin injections (also known as insulin on board) and adjusts the dose which prevents insulin stacking and so reducing hypo risk. 

 Is my insulin to carbohydrate ratio correct?  

Use your continuous glucose sensor to monitor your glucose after eating.   

If your glucose is in target 2 hours after eating your ratio is probably correct. 

If your glucose is always 2-3 mmol/L more or less than your pre-meal reading 2 hours after your meal, then you might need a stronger or weaker ratio.

 Keep moving

Try to be as active as possible every day.   

Movement after meals can help glucose levels in the hours after eating.

  What about high protein and high fat meals?

Meals that contain more than 30g fat or 40g protein can cause high glucose levels 3-5 hours after eating and may be tricky to manage.    

High fat and protein meals delay digestion and absorption of carbohydrate and cause some insulin resistance after the meal. Smaller amounts of fat or protein may impact the blood glucose levels of younger children.

High fat and/or high protein meals may require more insulin. 

You can use the Carbs & Cals ® book/app or food labels to identify the fat and protein content of meals. Use your sensor to monitor your glucose level after eating meals with more than 20-30g fat and/or 25g protein. If you notice a pattern of high glucose in the hours after eating, consider the following:  

Before making any adjustments check:  

• Is your carb count correct?  
• Are you injecting 15-20 minutes before eating?  
• Is your insulin to carbohydrate ratio correct?  

If your glucose is still above target:  

• For meals that cause high glucose 3-5 hours after eating, add an additional 25% to your carb count to increase the insulin dose.  
• You can use this table to help.

Carbohydrate you are going to eat (g)

Amount of carbohydrate to use for bolus calculation (g)

• If your glucose is high before eating, do not add additional insulin to the correction dose  
• If you eat these meals following very active days, you may not need any additional insulin, or you may need less additional insulin than you would on less active days.
• If you try this and are still finding high fat/protein meals tricky to manage, please contact the diabetes dietitians for help  

This information is based on the research and experience of Dr Carmel Smart and her team at the John Hunter Children's Hospital, Newcastle, Australia. We thank them for their support in producing this resource.