Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes

Abstract

Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.

Efficacy of traditional Chinese medication Tangminling pill in Chinese patients with type 2 diabetes

“…Hypoglycemia has been considered as a major barrier to the proper glycemic control in diabetic patients [69]. Our analyses revealed that Tangminling reduced blood glucose mildly, without hypoglycemic events reported.…”

Prospective evaluation of insulin‐to‐carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy

“…This gives them the flexibility of eating different meal sizes with adjustment of insulin doses according to the carbohydrate content of their meals. 4 This study found that bolus insulin requirements estimated by the 500 rule were lower than the actual bolus doses used by the study participants. These results confirmed the findings of other studies, which demonstrated that the 500 rule underestimated the insulin requirements for children and adolescents with T1DM.…”

“…Estimation of the ICR is essential for calculation of bolus insulin doses in children and adolescents with T1DM using carbohydrate counting. This gives them the flexibility of eating different meal sizes with adjustment of insulin doses according to the carbohydrate content of their meals …”

“…Moreover, the use of rapid‐acting insulin analogues, which have rapid onset of action but short duration resembling the normal body insulin response to carbohydrate content in different meals, allows the adjustment of premeal bolus doses according the amount of carbohydrates in each meal . Calculation of the premeal bolus insulin dose depends on the insulin‐to‐carbohydrate ratio (ICR) which is defined as the grams of carbohydrates covered by one unit of insulin …”

“…3 Calculation of the premeal bolus insulin dose depends on the insulin-to-carbohydrate ratio (ICR) which is defined as the grams of carbohydrates covered by one unit of insulin. 4 Although ICR needs to be individually assessed, several formulas have been proposed for estimation of ICR. 5 The 500/total daily dose (TDD) formula, by which the ICR is estimated through dividing 500 by the sum of both basal and bolus insulin doses used throughout the day, 2 is often used for initial estimation of ICR among children and adolescents with T1DM.…”