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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...
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| Published in: | Diabetic medicine 2009-03, Vol.26 (3), p.279-285 |
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| creator | Smart, C. E. Ross, K. Edge, J. A. Collins, C. E. Colyvas, K. King, B. R. |
| description | 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. |
| doi_str_mv | 10.1111/j.1464-5491.2009.02669.x |
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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.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/j.1464-5491.2009.02669.x</identifier><identifier>PMID: 19317823</identifier><identifier>CODEN: DIMEEV</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>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</subject><ispartof>Diabetic medicine, 2009-03, Vol.26 (3), p.279-285</ispartof><rights>2009 The Authors. Journal compilation © 2009 Diabetes UK</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5519-4851b9e7de88efbaaa7589a472f045f5741d7c6c21712660e5f27f3f2d976ac53</citedby><cites>FETCH-LOGICAL-c5519-4851b9e7de88efbaaa7589a472f045f5741d7c6c21712660e5f27f3f2d976ac53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1464-5491.2009.02669.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1464-5491.2009.02669.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21236808$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19317823$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smart, C. E.</creatorcontrib><creatorcontrib>Ross, K.</creatorcontrib><creatorcontrib>Edge, J. A.</creatorcontrib><creatorcontrib>Collins, C. E.</creatorcontrib><creatorcontrib>Colyvas, K.</creatorcontrib><creatorcontrib>King, B. R.</creatorcontrib><title>Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>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.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose - metabolism</subject><subject>Child</subject><subject>continuous subcutaneous insulin infusion</subject><subject>Diabetes Mellitus, Type 1 - blood</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Dietary Carbohydrates - metabolism</subject><subject>Dose-Response Relationship, Drug</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Hypoglycemia - blood</subject><subject>Hypoglycemia - drug therapy</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Infusions, Subcutaneous - methods</subject><subject>Insulin - administration & dosage</subject><subject>Insulin - analogs & derivatives</subject><subject>insulin analogues</subject><subject>Male</subject><subject>Medical sciences</subject><subject>paediatrics</subject><subject>postprandial glucose</subject><subject>Postprandial Period - drug effects</subject><subject>Statistics as Topic</subject><subject>Type 1 diabetes</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkc-P1CAUx4nRuOPqv2C46K1doFDagwczruvGXd2DP46EoXSHkUIF6k7P_uNSZzJeJSE88j7fB-_7AIAYlTivi12JaU0LRltcEoTaEpG6bsv9I7A6JR6DFeKUFBXi-Aw8i3GHECZt1T4FZ7itMG9ItQK_11tju6AdlK6DsvNWR6VditA7aFzSLppfOkdxssbBtNVBjjMcZM7lDUcf0xiy1kgL7-2spB6Mgsq7FLyFDyZt_ZTgGLQyUUMlw8Zv5y7IlC9-csm4--fgSS9t1C-O5zn4-v7yy_pDcfP56nr99qZQjOG2oA3Dm1bzTjeN7jdSSs6aVlJOekRZzzjFHVe1IpjjbAfSrCe8r3rStbyWilXn4PWh7hj8z0nHJAaTm7VWOu2nKGqOWEVZncHmAKrgYwy6F2MwgwyzwEgsAxA7sfgsFp_FMgDxdwBin6Uvj29Mm0F3_4RHxzPw6gjIqKTts3fZmRNHMKnqBjWZe3PgHozV839_QLy7vVyirC8OehOT3p_0MvzIfVacie-frgRu-N3dx29U3FZ_AClJtAo</recordid><startdate>200903</startdate><enddate>200903</enddate><creator>Smart, C. E.</creator><creator>Ross, K.</creator><creator>Edge, J. A.</creator><creator>Collins, C. E.</creator><creator>Colyvas, K.</creator><creator>King, B. R.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200903</creationdate><title>Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting</title><author>Smart, C. E. ; Ross, K. ; Edge, J. A. ; Collins, C. E. ; Colyvas, K. ; King, B. R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5519-4851b9e7de88efbaaa7589a472f045f5741d7c6c21712660e5f27f3f2d976ac53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose - metabolism</topic><topic>Child</topic><topic>continuous subcutaneous insulin infusion</topic><topic>Diabetes Mellitus, Type 1 - blood</topic><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Dietary Carbohydrates - metabolism</topic><topic>Dose-Response Relationship, Drug</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Hypoglycemia - blood</topic><topic>Hypoglycemia - drug therapy</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Infusions, Subcutaneous - methods</topic><topic>Insulin - administration & dosage</topic><topic>Insulin - analogs & derivatives</topic><topic>insulin analogues</topic><topic>Male</topic><topic>Medical sciences</topic><topic>paediatrics</topic><topic>postprandial glucose</topic><topic>Postprandial Period - drug effects</topic><topic>Statistics as Topic</topic><topic>Type 1 diabetes</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smart, C. E.</creatorcontrib><creatorcontrib>Ross, K.</creatorcontrib><creatorcontrib>Edge, J. A.</creatorcontrib><creatorcontrib>Collins, C. E.</creatorcontrib><creatorcontrib>Colyvas, K.</creatorcontrib><creatorcontrib>King, B. R.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smart, C. E.</au><au>Ross, K.</au><au>Edge, J. A.</au><au>Collins, C. E.</au><au>Colyvas, K.</au><au>King, B. R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2009-03</date><risdate>2009</risdate><volume>26</volume><issue>3</issue><spage>279</spage><epage>285</epage><pages>279-285</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><coden>DIMEEV</coden><notes>istex:083EBAE63C8F8C2A749BDEFE9D5C62A637E079A9</notes><notes>ark:/67375/WNG-187PPKV4-M</notes><notes>ArticleID:DME2669</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19317823</pmid><doi>10.1111/j.1464-5491.2009.02669.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting |
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