Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting

Aims  Carbohydrate (CHO) quantification is used to adjust pre‐meal insulin in intensive insulin regimens. However, the precision in CHO quantification required to maintain postprandial glycaemic control is unknown. We determined the effect of a ±10‐g variation in CHO amount, with an individually cal...

Full description

Saved in:
Bibliographic Details
Published in:Diabetic medicine 2009-03, Vol.26 (3), p.279-285
Main Authors: Smart, C. E., Ross, K., Edge, J. A., Collins, C. E., Colyvas, K., King, B. R.
Format: Article
Language:English
Subjects:
Adolescent
Biological and medical sciences
Blood Glucose - metabolism
Child
continuous subcutaneous insulin infusion
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - drug therapy
Diabetes. Impaired glucose tolerance
Dietary Carbohydrates - metabolism
Dose-Response Relationship, Drug
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Humans
Hypoglycemia - blood
Hypoglycemia - drug therapy
Hypoglycemic Agents - administration & dosage
Infusions, Subcutaneous - methods
Insulin - administration & dosage
Insulin - analogs & derivatives
insulin analogues
Male
Medical sciences
paediatrics
postprandial glucose
Postprandial Period - drug effects
Statistics as Topic
Type 1 diabetes
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Aims  Carbohydrate (CHO) quantification is used to adjust pre‐meal insulin in intensive insulin regimens. However, the precision in CHO quantification required to maintain postprandial glycaemic control is unknown. We determined the effect of a ±10‐g variation in CHO amount, with an individually calculated insulin dose for 60 g CHO, on postprandial glycaemic control. Methods  Thirty‐one children and adolescents (age range 9.5–16.8 years), 17 using continuous subcutaneous insulin infusion (CSII) and 14 using multiple daily injections (MDI), participated. Each subject consumed test lunches of equal macronutrient content, differing only in carbohydrate quantity (50, 60, 70 g CHO), in random order on three consecutive days. For each participant, the insulin dose was the same for each meal, based on their usual insulin : CHO ratio for 60 g CHO. Activity was standardized. Continuous glucose monitoring was used. Results  The CSII and MDI subjects demonstrated no difference in postprandial blood glucose levels (BGLs) for comparable carbohydrate loads (P > 0.05). The 10‐g variations in CHO quantity resulted in no differences in BGLs or area under the glucose curves for 2.5 h (P > 0.05). Hypoglycaemic episodes were not significantly different (P = 0.32). The 70‐g meal produced higher glucose excursions after 2.5 h, with a maximum difference of 1.9 mmol/l at 3 h (P = 0.01), but the BGLs remained within international postprandial targets. Conclusions  In patients using intensive insulin therapy, an individually calculated insulin dose for 60 g of carbohydrate maintains postprandial BGLs for meals containing between 50 and 70 g of carbohydrate. A single mealtime insulin dose will cover a range in carbohydrate amounts without deterioration in postprandial control.
ISSN:0742-3071
1464-5491
DOI:10.1111/j.1464-5491.2009.02669.x