title: The relationship between carbohydrate and the mealtime insulin dose in type 1 diabetes.
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.
authors.affiliation: Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia.
authors.forename: Kirstine J
authors.initials: KJ
authors.lastname: Bell
authors.affiliation: 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.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: King
authors.affiliation: Physiology, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Amir
authors.initials: A
authors.lastname: Shafat
authors.affiliation: 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.
authors.forename: Carmel E
authors.initials: CE
authors.lastname: Smart
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D000067940:Glycemic Load; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D062407:Meals; D010349:Patient Compliance
chemical_list: D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Carbohydrate; Carbohydrate-to-insulin ratio; Insulin; Postprandial glycemia; Type 1 diabetes