Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus (ultralente-regular) insulin regimen

• Published in: Diabetes care Vol. 22; no. 5; pp. 667 - 673
• Main Authors: Rabasa-Lhoret, R, Garon, J, Langelier, H, Poisson, D, Chiasson, J.L
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.05.1999
• Subjects: Adult; Biological and medical sciences; blood; Blood Glucose; Blood Glucose - metabolism; Cross-Over Studies; diabetes mellitus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; dietary carbohydrate; Dietary Carbohydrates; drug therapy; Drug Therapy, Combination; Eating; Energy Intake; Female; Hormones. Endocrine system; Humans; Hypoglycemic Agents; Hypoglycemic Agents - therapeutic use; insulin; Insulin - therapeutic use; insulin therapy; Insulin, Long-Acting; Insulin, Long-Acting - therapeutic use; insulin-dependent diabetes mellitus; Male; meals; Medical sciences; metabolism; Middle Aged; patients; Pharmacology. Drug treatments; Postprandial Period; Regression Analysis; requirements; therapeutic use; Canada; North America; America; Endocrinopathy; Human; Immunopathology; Pancreatic hormone; Autoimmune disease; Supplemented diet; Insulin; Protein hormone; Insulin dependent diabetes; Adult; Carbohydrate; Therapeutic protocol; Restricted diet; Dose; Insulin zinc suspension(crystalline); Comparative study; Intensive insulin regimen
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.22.5.667

Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus (ultralente-regular) insulin regimen. R Rabasa-Lhoret , J Garon , H Langelier , D Poisson and J L Chiasson Research Center, Centre Hospitalier de l'Université de Montréal, Ontario, Canada. Abstract OBJECTIVE: In this study, we evaluated the effects of high-(55%) and low-(40%) carbohydrate diets on insulin requirements in nine type 1 diabetic subjects treated intensively with ultralente as basal insulin and regular insulin as premeal insulin adjusted to the carbohydrate content of meals. RESEARCH DESIGN AND METHODS: Nine subjects were randomized in a crossover design to follow two diets consecutively for a period of 14 days each. A 3-day food diary was completed for each diet with the amount of carbohydrate in the mixed meals ranging from 21 to 188 g. Preprandial (5.9 vs. 6.1 mmol/l) and postprandial (8 vs. 8.9 mmol/l) capillary glucose and fructosamine (310 vs. 316 mumol/l) were comparable on both the low- and high-carbohydrate diets. RESULTS: The assessment of meal carbohydrate content by the patients was excellent, with > 85% of cases falling within 15% of computer-assisted evaluation. When premeal regular insulin was prescribed in U/10 g of carbohydrate, the postprandial glycemic rise remained constant (2.4 +/- 2.8 mmol/l) over a wide range of carbohydrate ingested (21-188 g) and was not affected by the glycemic index, fiber, and caloric and lipidic content of the meals. This tight control was maintained during the low- and high-carbohydrate diet without any change in insulin requirements (breakfast, 1.5 vs. 1.5 U/10 g of carbohydrate; lunch, 1.0 vs. 1.0; supper, 1.1 vs. 1.2) and in basal ultralente insulin requirements (22.5 vs. 21.4 U/day). CONCLUSIONS: These results indicate that in type 1 diabetic subjects 1) increasing the amount of carbohydrate intake does not influence glycemic control if premeal regular insulin is adjusted to the carbohydrate content of the meals; 2) algorithms based on U/10 g of carbohydrate are effective and safe, whatever the amount of carbohydrate in the meal; 3) the glycemic index, fiber, and lipidic and caloric content of the meals do not affect premeal regular insulin requirements; 4) wide variations in carbohydrate intake do not modify basal (ultralente) insulin requirements; and, finally 5) the ultralente-regular insulin regimen allows dissection between basal and prandial insulin requirements, so that each can be adjusted accurately and independently.