Pathophysiology and Management of Type 1 Diabetes
Emmanuel C. Opara, Sam Dagogo-Jack in Nutrition and Diabetes, 2019
An even more simplified approach, for those who cannot count carbohydrates or maintain a consistent carbohydrate diet, is to dose insulin based on estimated carbohydrate content or meal size. For example, a patient may be instructed to take 3 units for a small or low-carbohydrate meal, 5 units for an average meal, and 7 units for a large or high-carbohydrate meal. While this approach provides some guidance for adjusting insulin based on nutritional intake, it is relatively imprecise and is likely to lead to increased glycemic variability. When appropriate, patients should be encouraged to adopt more sophisticated methods of carbohydrate counting and insulin dosing. Ongoing interaction with certified diabetes educators and registered dieticians is important for all individuals with diabetes in order to achieve or maintain treatment goals.
Insulins and insulin management
Janet Titchener in Diabetes Management, 2020
Packaged foods are legally required to document the grams of carbohydrate per serving. Non-packaged foods such as fruit and vegetables obviously do not come with this information, but multiple resources are available to assist with carbohydrate counting: Reference books, available at any bookstore or on the web. One of the best is Calorie Fat and Carbohydrate Counter by Allan Borushek (Family Health Publications, 2020). www.CalorieKing.comAmerican Diabetes Association website.Carbohydrate counting apps for phones/computers
Traditional and Nontraditional Treatments for Diabetes
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
Carbohydrate counting, another method for meal planning, focuses only on maintaining a consistent amount of this macronutrient throughout the day by meals and snacks. The guidelines stress carbohydrate counting should be considered as a foundational dietary strategy for maintaining glycemic control [8,27]. According to the Academy of Nutrition and Dietetics, evidence-based guidelines for persons with type 1 or type 2 diabetes taking multiple insulin injections or who are on an insulin pump, carbohydrate intake should be matched with insulin needs. This is accomplished by using carbohydrate counting and established, individualized carbohydrate-to-insulin ratios [25]. Even though there is clear evidence that maintaining a consistent carbohydrate intake is beneficial, the ideal amount of carbohydrate as a percentage of the total calories is inconclusive. Therefore, it is recommended that “experience-based estimation” and carbohydrate counting are two good methods to use when establishing the ideal carbohydrate content of a person’s diet [27]. Maintaining a carbohydrate-consistent diet has shown improvement in blood glucose stability and plays an important role in regulating post-meal blood glucose excursions, as carbohydrate quality and amount are the best predictors of changes in blood glucose levels [35,36,40].
Normo-Carbohydrate Nutrition: Results from a Pilot Study
Published in Journal of Community Health Nursing, 2018
Jamie Leslie
NCN is a plan for healthy nutrition developed by the PI/RN based on carbohydrate counting. Carbohydrate counting is an accepted method of nutrition for people with diabetes and gestational diabetes (Warshaw & Bolderman, 2008). This approach was adopted along with two other principles to develop a comprehensive nutritional plan. The four principles comprising NCN include limit carbohydrate intake,eat every 2.5–3 h,eat at least one serving of fiber daily, andmeasure yourself weekly.
Half unit insulin pen: an effective yet underutilized insulin delivery option
Published in Current Medical Research and Opinion, 2021
Debmalya Sanyal, Amarta Shankar Chowdhury
Insulin may be administered through a syringe that is filled from a vial, an insulin pen or an insulin pump – continuous subcutaneous insulin infusion (CSII). Syringes are inexpensive, but they can be inconvenient, indiscreet and have a greater risk of inaccuracy. Syringes also pose a barrier to appropriate and accurate dosing in patients with visual or physical impairment8. On the other hand, insulin pens have been designed to overcome these barriers in insulin therapy10–12. Most of the available pens in the market deliver insulin in 1 U increments, a few deliver in half-units (0.5 U). Half-unit pens (HUPs), compared to 1 U pens, can further improve the accuracy and precision in insulin therapy13. Young people and elderly, who need very small insulin dosages, are much benefited by the use of HUPs. Carbohydrate counting improves glycemic control and reduces glycemic variability. Half unit insulin delivery can more effectively match the insulin to carbohydrate ratio in people using carbohydrate counting to calculate insulin dose9,13. The main purpose of HUPs is to provide accurate insulin administration to an insulin-sensitive patient. HUPs improve treatment adherence leading to better clinical outcome and quality of life13. HUPs that are available in the market are HumaPen Luxura HDi, NovoPen Echoii, JuniorSTARiii, Humalog Junior Kwikpeniv, and InPenv,9.
Carbohydrate counting in type 1 diabetes mellitus: dietitians’ perceptions, training and barriers to use
Published in South African Journal of Clinical Nutrition, 2022
Megan Esmè Dimitriades, Kirthee Pillay
There was significant agreement among the dietitians that carbohydrate counting could only be taught alongside intensive insulin therapy or multiple daily injections and that all patients with diabetes on insulin therapy could be taught some form of carbohydrate counting. Dietitians believed that there was a strong evidence base for teaching carbohydrate counting to patients with T1DM. Although the ADA recommend carbohydrate counting, there are no South African guidelines that discuss carbohydrate counting in the context of T1DM. Although dietitians had a positive perception on the use of carbohydrate counting, they identified a need for further training in its use. Dietitians strongly agreed that they required further training or education in the use of carbohydrate counting as a dietary management approach to manage patients with T1DM and were willing to attend a teaching/training session in the use of carbohydrate counting, if it was to be available to them. This finding motivates towards training in the use of carbohydrate counting to be made available to dietitians. Other dietitians, who have a special interest in the field of diabetes or have received additional training in the area of carbohydrate counting, could deliver this training. Very few indicated that they had specialised training in diabetes management, which also suggests that there is a need for further training in diabetes management. Dietitians felt that they did not receive adequate training in carbohydrate counting in their undergraduate degree. This suggests that universities which offer an undergraduate dietetics degree should consider increasing the amount of training offered in carbohydrate counting.