Carb-to-Insulin Ratio (ICR) Calculator
Type-1 diabetics on multiple-daily-injection or insulin-pump therapy (and type-2 diabetics on basal-bolus) need to compute a meal bolus that combines (a) covering the meal's carbohydrate load and (b) correcting current blood glucose back to target. Enter: (1) total daily insulin dose (TDD = basal + all boluses); (2) insulin type (rapid or regular); (3) meal carbs in grams; (4) current and target BG in mg/dL or mmol/L. The tool applies the canonical Walsh & Roberts "Pumping Insulin" **500 / 1800 rules** (rapid-acting analogues) or **450 / 1500 rules** (regular insulin) to give: (a) personalised ICR (grams of carb per 1 U); (b) personalised ISF (BG drop per 1 U); (c) suggested total bolus. ⚠ **Educational only** — not medical advice. Discuss any dose change with an endocrinologist or certified diabetes educator (CDE).
Enter a valid TDD (1–500 U), carbs (0–500 g) and positive blood-glucose values.
Suggested total bolus
8.2
U
—
Carb-to-insulin ratio (ICR)
1 U : 10 g
Insulin sensitivity factor (ISF)
1 U ↓ 36
Formula
ICR (g/U) = (500 rapid / 450 regular) ÷ TDD ISF = (1800 / 100) ÷ TDD (mg/dL or mmol/L) bolus = carbs ÷ ICR + max(0, (BG − target) ÷ ISF)
References: (1) Walsh & Roberts "Pumping Insulin" 6th ed. (2017) — origin of the 500 / 450 / 1800 / 1500 rules; (2) ADA Standards of Care 2024 §9; (3) Davidson PC et al. (2008) Endocrine Practice — adult-T1D ICR clinical validation. **Important disclaimer**: this tool is for education and self-orientation only — any actual dose change must be reviewed by your endocrinologist or certified diabetes educator (CDE). The 500/450/1800/1500 rules are starting estimates only; individual ICR/ISF should be refined with CGM data and food logs. **Safety**: (a) never bolus during hypoglycaemia (< 70 mg/dL / 3.9 mmol/L); (b) account for insulin-on-board (IOB) — rapid-acting insulin lasts ~3–5 h; (c) TDD shifts during exercise, illness or menstruation.
Formula
ICR (g/U) = 500 ÷ TDD (rapid: lispro, aspart, glulisine) ICR (g/U) = 450 ÷ TDD (regular human insulin) ISF (mg/dL/U) = 1800 ÷ TDD (rapid) ISF (mmol/L/U) = 100 ÷ TDD (rapid) ISF (mg/dL/U) = 1500 ÷ TDD (regular) ISF (mmol/L/U) = 83.3 ÷ TDD (regular) bolus = carbs ÷ ICR + max(0, (BG_current − BG_target) ÷ ISF) Unit conversion: 1 mmol/L = 18.0182 mg/dL
- · **⚠ Important disclaimer**: this tool is for diabetes-aware education and self-orientation only — it is **not** medical advice. Any dose change must be reviewed by your endocrinologist, certified diabetes educator (CDE) or diabetes team. The 500/450/1800/1500 rules are starting estimates; your final ICR/ISF should be refined using CGM data, food logs and clinical observation.
- · **Calculating TDD**: TDD = basal insulin (long-acting glargine / degludec / detemir, or pump basal) + all meal boluses + all corrections, averaged over 5–7 consecutive days. **Do not use a single peak day** (illness, menstruation); use a steady-state average. **For new pump users**: a common starting point is 50 % TDD as basal and the remaining 50 % split across 3 meals — refined with CGM data over the first week.
- · **Origin of the 500 rule**: Walsh & Roberts, "Pumping Insulin" (2017, 6th ed.) — derived from clinical observation that 1 U of rapid-acting insulin covers ~10–15 g carbs at TDDs of 33–50 U. **Personal variance is large**: (1) children / teens (growth hormone): use 350–450/TDD; (2) breakfast dawn phenomenon — morning ICR is usually 30 % tighter than lunch / dinner; (3) menstrual luteal phase — needs rise 10–20 % in many women; (4) for 12–48 h after exercise — needs drop ~20 %.
- · **Insulin-on-board (IOB) matters**: this tool does **not** subtract IOB — but real-world dosing must. Rapid-acting peaks at 1–2 h and tails over 4–5 h. If your last bolus was < 4 h ago, **subtract the remaining IOB from the suggested dose** (pumps do this automatically). **Example**: tool suggests 8 U; 3 h ago you took 6 U → with 4-h linear decay, remaining IOB = 6 × (1 − 3/4) = 1.5 U → take 8 − 1.5 = 6.5 U. **Skipping IOB** = "stacking" = hypoglycaemia.
- · **When this tool is NOT appropriate**: (1) **hypoglycaemia** (< 70 mg/dL / 3.9 mmol/L) — do not bolus; take fast carbs first; (2) **DKA** (BG > 250 mg/dL with ketones) — needs urgent medical care, not a bolus calculator; (3) **illness, fever, infection** — TDD rises 10–25 %; consult your team rather than scaling alone; (4) **T1D honeymoon phase** — TDD shifts daily; rely on CGM and close clinical follow-up; (5) **type-2 diabetes on oral agents** — clarify the bolus framework with your endocrinologist first.
- · **Advanced: carb quality and GI**: the 500 rule assumes a mixed meal (complex carb + protein + fat). High-GI meals (white rice, sugary drinks, gummy sweets) hit faster — use a split bolus (60 % now + 40 % at +1 h); high-protein / high-fat meals need an extended (square-wave) bolus on a pump. **FPU rule**: one Fat-Protein Unit (100 kcal of fat + protein) requires ~10 g-equivalent of delayed insulin — used for pizza, carbonara and similar slow-emptying meals.
- · **References**: (1) Walsh J, Roberts R., "Pumping Insulin" 6th ed. (2017) — origin of the 500 / 1800 rules; (2) ADA "Standards of Care in Diabetes" 2024, §9 Pharmacologic Approaches; (3) Davidson PC et al. (2008) "Insulin-to-Carbohydrate Ratio and Insulin Sensitivity Factor in Adults with T1D", Endocr Pract 14(8):1095; (4) ISPAD Clinical Practice Consensus Guidelines 2022 (paediatric edition); (5) JDRF/IDF Time-In-Range consensus (2019) — target 70–180 mg/dL / 3.9–10 mmol/L > 70 % of time.
Frequently asked
How do I know if my ICR should differ across breakfast, lunch and dinner?
**Short answer: for most adults, ICR is *not* the same at all three meals**. **Typical pattern (adult T1D)**: (1) **breakfast ICR is the tightest** (covers the *fewest* carbs per U) because of the dawn phenomenon — growth hormone and cortisol rising 5–8 AM drive 20–40 % more insulin resistance and liver glucose output; (2) **lunch ICR is in between**; (3) **dinner ICR is the loosest** — closest to your basal sensitivity. **Typical ratio**: breakfast : lunch : dinner ≈ 1 : 1.2 : 1.4. **How to verify**: (1) wear a CGM for 5–7 days; (2) carb-count every meal (e.g. Carb Manager); (3) use this tool to compute the bolus; (4) check 3-h post-meal BG — it should be within ±30 mg/dL (±1.7 mmol/L) of target. If it consistently runs high at one meal, **tighten the ICR for that meal** (e.g. from 1:10 to 1:8); if it runs low, loosen it. **Adjust 5–10 % at a time** and review after 5–7 meals. Combining this with CGM Time-In-Range data resolves three separate ICRs within a month.
My family member's TDD keeps changing — how do they find a stable ICR?
**Common causes of shifting TDD**: (1) **honeymoon phase in newly diagnosed T1D** — residual β-cell secretion bounces back intermittently for months, swinging TDD from 25 U/day up to 50 U/day. **Approach**: re-compute ICR weekly using fresh CGM data — do *not* default to last week's value; (2) **growth in children / teens**: GH rises drive TDD up 0.5–1 U/kg/day per year — re-evaluate every 3 months; (3) **seasonal shifts**: ICR runs 10–15 % looser in summer (warmth dilates subcutaneous vessels, raising absorption) — keep two ICR sets and label them; (4) **drug effects**: corticosteroids (e.g. prednisolone) drive TDD up 30–50 % immediately and decay 1–2 weeks after stopping. GLP-1 receptor agonists (Mounjaro, Ozempic) drop T2D TDD 20–40 %; (5) **weight change**: +5 % body fat raises TDD ~10 %. **To stabilise an ICR**: (a) collect 14 days of CGM + food log; (b) discard "abnormal" days (hypo, stacking, missed bolus); (c) average TDD over 7–10 steady-state days; (d) apply 500/1800 to that average; (e) reassess every 2 weeks with 5 % adjustments. **TIR > 70 %** is the KPI for ICR stability.
I'm in a country that uses mmol/L (HK, UK, AU) — does the formula change?
**The 500/450 ICR rules are unit-independent** (input is grams, output is U/g). **The ISF rules do change with unit**: (1) the 1800 mg/dL rule (rapid-acting) ÷ 18.0182 = the ~100 rule in mmol/L; (2) the 1500 mg/dL rule (regular) ÷ 18.0182 = the ~83.3 rule in mmol/L. This tool applies the correct version based on the unit you pick. **Example**: TDD 50 U/day of rapid-acting: (a) mg/dL: ISF = 1800/50 = 36 mg/dL per U; (b) mmol/L: ISF = 100/50 = 2 mmol/L per U. Check: 36 ÷ 18.0182 = 2.0 mmol/L ✓. **Regional equivalents**: (1) pre-meal target — US 80–130 mg/dL ≈ HK/UK 4.4–7.2 mmol/L; (2) 2-h post-meal upper — US < 180 mg/dL ≈ HK/UK < 10 mmol/L; (3) hypo alarm — US 70 mg/dL = HK/UK 3.9 mmol/L; (4) DKA threshold — US 250 mg/dL = HK/UK 13.9 mmol/L. **Note**: HbA1c reporting (DCCT % vs IFCC mmol/mol) is a separate question and is independent of this calculation.
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