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J Diabetes Complications. 2015 Nov-Dec;29(8):1323-9. doi: 10.1016/j.jdiacomp.2015.08.014. Epub 2015 Aug 20.

The relationship between carbohydrate and the mealtime insulin dose in type 1 diabetes.

Author information

1
Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia.
2
Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia; Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.
3
Physiology, School of Medicine, National University of Ireland, Galway, Ireland.
4
Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia; Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia. Electronic address: Carmel.Smart@hnehealth.nsw.gov.au.

Abstract

A primary focus of the nutritional management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. Different methods exist to quantify carbohydrate including counting in one gram increments, 10g portions or 15g exchanges. Clinicians have assumed that counting in one gram increments is necessary to precisely dose insulin and optimize postprandial control. Carbohydrate estimations in portions or exchanges have been thought of as inadequate because they may result in less precise matching of insulin dose to carbohydrate amount. However, studies examining the impact of errors in carbohydrate quantification on postprandial glycemia challenge this commonly held view. In addition it has been found that a single mealtime bolus of insulin can cover a range of carbohydrate intake without deterioration in postprandial control. Furthermore, limitations exist in the accuracy of the nutrition information panel on a food label. This article reviews the relationship between carbohydrate quantity and insulin dose, highlighting limitations in the evidence for a linear association. These insights have significant implications for patient education and mealtime insulin dose calculations.

KEYWORDS:

Carbohydrate; Carbohydrate-to-insulin ratio; Insulin; Postprandial glycemia; Type 1 diabetes

PMID:
26422396
DOI:
10.1016/j.jdiacomp.2015.08.014
[Indexed for MEDLINE]

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