title: Improving the estimation of mealtime insulin dose in adults with type 1 diabetes: the Normal Insulin Demand for Dose Adjustment (NIDDA) study.
abstract: OBJECTIVE
  Although carbohydrate counting is routine practice in type 1 diabetes, hyperglycemic episodes are common. A food insulin index (FII) has been developed and validated for predicting the normal insulin demand generated by mixed meals in healthy adults. We sought to compare a novel algorithm on the basis of the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes.
  
  
  METHODS
  A total of 28 patients using insulin pump therapy consumed two different breakfast meals of equal energy, glycemic index, fiber, and calculated insulin demand (both FII = 60) but approximately twofold difference in carbohydrate content, in random order on three consecutive mornings. On one occasion, a carbohydrate-counting algorithm was applied to meal A (75 g carbohydrate) for determining bolus insulin dose. On the other two occasions, carbohydrate counting (about half the insulin dose as meal A) and the FII algorithm (same dose as meal A) were applied to meal B (41 g carbohydrate). A real-time continuous glucose monitor was used to assess 3-h postprandial glycemia.
  
  
  RESULTS
  Compared with carbohydrate counting, the FII algorithm significantly decreased glucose incremental area under the curve over 3 h (-52%, P = 0.013) and peak glucose excursion (-41%, P = 0.01) and improved the percentage of time within the normal blood glucose range (4-10 mmol/L) (31%, P = 0.001). There was no significant difference in the occurrence of hypoglycemia.
  
  
  CONCLUSIONS
  An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes.
authors.affiliation: Boden Institute of Obesity, Nutrition & Exercise and the School of Molecular Biosciences, University of Sydney, Sydney, Australia.
authors.forename: Jiansong
authors.initials: J
authors.lastname: Bao
authors.forename: Heather R
authors.initials: HR
authors.lastname: Gilbertson
authors.forename: Robyn
authors.initials: R
authors.lastname: Gray
authors.forename: Diane
authors.initials: D
authors.lastname: Munns
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Howard
authors.forename: Peter
authors.initials: P
authors.lastname: Petocz
authors.forename: Stephen
authors.initials: S
authors.lastname: Colagiuri
authors.forename: Jennie C
authors.initials: JC
authors.lastname: Brand-Miller
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005215:Fasting / Q000097:blood; D005260:Female; D005502:Food; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin