Carbohydrate counting and insulin dose adjustment group sessions for type 1 diabetes: a pilot of their effectiveness at a primary care diabetes centre

2013 ◽  
Vol 30 (9) ◽  
pp. 366-368a
Author(s):  
Julie Taplin ◽  
Nicola Allen
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Carbohydrate Counting ◽  
Group Sessions

Development of Online Modules for Intensive Insulin Dose Adjustment Education for Parents of Children With Type 1 Diabetes

2013 ◽  
Vol 28 (2) ◽  
pp. 203
Author(s):  
Cristina Pepe ◽  
Sharleen Herrmann ◽  
Heather Nichol ◽  
Daniel L. Metzger
Keyword(s):  
Type 1 Diabetes ◽  
Dose Adjustment ◽  
Insulin Dose

scholarly journals Improving the Estimation of Mealtime Insulin Dose in Adults With Type 1 Diabetes: The Normal Insulin Demand for Dose Adjustment (NIDDA) study

Diabetes Care ◽  
2011 ◽  
Vol 34 (10) ◽  
pp. 2146-2151 ◽  
Author(s):  
J. Bao ◽  
H. R. Gilbertson ◽  
R. Gray ◽  
D. Munns ◽  
G. Howard ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Mealtime Insulin

scholarly journals A novel approach to basal-bolus insulin initiation in adults with newly diagnosed type 1 diabetes: an observational cohort study of a service redesign

2018 ◽  
Vol 18 (2) ◽  
pp. 71-75
Author(s):  
Helen E Hopkinson ◽  
Anna D White ◽  
Peter Nightingale ◽  
Parth Narendran
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Basal Insulin ◽  
Dose Adjustment ◽  
Newly Diagnosed ◽  
Insulin Initiation ◽  
Carbohydrate Counting ◽  
Bolus Insulin ◽  
Basal Bolus

Aims: The National Institute for Health and Care Excellence (NICE) recommendation for insulin in newly diagnosed type 1 diabetes is a ‘basal-bolus’ regimen of prandial insulin with twice-daily basal insulin initiated at diagnosis. We developed an insulin initiation programme that embraces the contribution of endogenous insulin to glycaemic control in adults newly diagnosed with type 1 diabetes. Our aim was to embed carbohydrate counting skills and dose adjustment very early on to mitigate against the decline in glycaemic control that is commonly seen post honeymoon.Methods: We designed a novel insulin initiation programme that focused initially on prandial insulin replacement using the lowest possible dose of basal insulin. The approach also facilitates carbohydrate counting and bolus insulin dose adjustment behaviours from diagnosis.Results: Prior to implementing the new programme, the mean HbA1c at 12 months was 64 mmol/mol (8.0%) (95% CI 60 to 69 (7.6% to 8.4%)). This reduced to 55 mmol/mol (7.1%) (95% CI 51 to 58 (6.9% to 7.4%)), p<0.001 with the new programme. The improved HbA1c persisted to 3 years of follow-up (p<0.001). There were no episodes of diabetic ketoacidosis or severe hypoglycaemia associated with this novel approach.Conclusions: We suggest that using minimal basal insulin and focusing on prandial bolus insulin replacement in adults newly diagnosed with type 1 diabetes is safe, more physiological and may be better able to achieve lasting glycaemic control than the currently proposed national guidelines. This approach will need to be tested formally in an adequately designed randomised controlled clinical trial.

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

2017 ◽  
Vol 70 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Roberto Luís Zagury ◽  
Melanie Rodacki ◽  
Larissa Mello de Oliveira ◽  
Claudia Saunders ◽  
Patricia de Carvalho Padilha ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Regular Insulin ◽  
Sensitivity Factor ◽  
Third Trimester ◽  
Progressive Reduction ◽  
Self Monitoring ◽  
Carbohydrate Counting ◽  
Daily Insulin Dose

Background/Aims: Carbohydrate counting (CC) is a helpful strategy for the treatment of type 1 diabetes mellitus (T1DM) and the main parameters used in this method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF). Throughout pregnancy, a state of insulin resistance develops. Therefore, we hypothesized that ICR and SF change and our aim was to describe the pattern of modification of these parameters in pregnant women with T1DM on CC. Methods: This study followed 21 women with T1DM throughout pregnancy. Starting ICR was 1:15 and SF was calculated using the formula: 1,500/total daily insulin dose (TDID; for regular insulin) or 1,800/TDID (for ultra-rapid analogs). ICR was adjusted every 1-2 weeks according to self-monitoring of blood glucose. SF was recalculated every 1-2 weeks. Results: Throughout gestation there was a mean decrease in the ICR in breakfast, lunch and dinner of 8.2 (p < 0.0001), 7.7 (p = 0.003) and 7 (p = 0.005) grams per international units (g/IU), respectively. Mean SF reduction from first to third trimester was 10 mg/dL per IU (mg/dL/IU; p < 0.0001). Conclusions: Women with T1DM in CC during pregnancy evolve with a progressive reduction in the ICR at every meal (mean of 8.2 g/IU for breakfast, 7.7 g/IU for lunch and 7 g/IU for dinner) and also in the SF (10 mg/dL/IU).

scholarly journals Influence of Flexible Insulin Dosing with Carbohydrate Counting Method on Metabolic and Clinical Parameters in Type 1 Diabetes Patients

2018 ◽  
Vol 6 (8) ◽  
pp. 1431-1434 ◽  
Author(s):  
Feyzi Gokosmanoglu ◽  
Attila Onmez
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Standard Dose ◽  
Insulin Dose ◽  
Hdl Cholesterol ◽  
Clinical Parameters ◽  
Counting Method ◽  
Carbohydrate Counting

Objective: The purpose of providing and maintaining a proper metabolic control is to prevent the development of chronic complications. In this study, we aimed to determine the influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients.Material and Method: This study was conducted with patients following up at the Endocrinology Clinic with a diagnosis of type 1 diabetes mellitus between 2012 and 2015. Metabolic and clinical parameters before and after carbohydrate counting were compared.Results: Forty patients were included to the study. Of the patients, 40% (n=16) were female and 60% (n=24) were male, and mean age was 21.5±7 year at the time of diagnosis. Statistically significant differences were not detected when hemoglobin A1c, fasting plasma glucose, post-prandial glucose, LDL-cholesterol, and HDL-cholesterol levels were compared at standard dose insulin use and after carbohydrate counting (p<0.005). Among the parameters measured when the patients received standard dose insulin without counting carbohydrate and flexible insulin dosing by counting carbohydrate, statistically significant differences were not detected for baseline insulin dose, bolus insulin dose, triglyceride level, body mass index, or monthly hypoglycemia episodes (p>0.05).Conclusion: Flexible insulin dosing with carbohydrate counting provides significant improvements in clinical and metabolic control. We detected improvements in lipid profiles and glycemic control. Additionally, patients generally did not gain weight despite flexible nutrition, and frequency of hypoglycemia remained unchanged despite strict glycemic control.OBJECTIVE: The purpose of providing and maintaining a proper metabolic control is to prevent the development of chronic complications. In this study, we aimed to determine the influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients.MATERIAL AND METHODS: This study was conducted with patients following up at the Endocrinology Clinic with a diagnosis of type 1 diabetes mellitus between 2012 and 2015. Metabolic and clinical parameters before and after carbohydrate counting were compared.RESULTS: Forty patients were included in the study. Of the patients, 40% (n = 16) were female, and 60% (n = 24) were male, and mean age was 21.5 ± 7 year at the time of diagnosis. Statistically significant differences were not detected when haemoglobin A1c, fasting plasma glucose, post-prandial glucose, LDL-cholesterol, and HDL-cholesterol levels were compared at standard dose insulin use and after carbohydrate counting (P < 0.005). Among the parameters measured when the patients received standard dose of insulin without counting carbohydrate and flexible insulin dosing by counting carbohydrate, statistically, significant differences were not detected for baseline insulin dose, bolus insulin dose, triglyceride level, body mass index, or monthly hypoglycemia episodes (P > 0.05).CONCLUSION: Flexible insulin dosing with carbohydrate counting provides significant improvements in clinical and metabolic control. We detected improvements in lipid profiles and glycemic control. Additionally, patients generally did not gain weight despite flexible nutrition, and frequency of hypoglycemia remained unchanged despite strict glycemic control.

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