Carbohydrate and preprandial insulin determination in diabetes: a review

Abstract

Aim: This review evaluates the various methods of determining preprandial insulin doses in relation to carbohydrate intake. Methods: A search was conducted in the Medline and ProQuest databases. Intervention or discussion papers involving insulin requirements and carbohydrate estimation, or the glycaemic response to food were reviewed. Results: The amount of carbohydrate and the glycaemic index both significantly affect glycaemic response and insulin requirements. Most carbohydrate estimation methods improve glycaemic control and some reduce hypoglycaemia. Carbohydrate ‘counting’ involves more complex processes, has a higher patient burden than qualitative methods and may lead to negative food choices. Conclusions: No one method of carbohydrate estimation is better at predicting preprandial insulin requirements. Qualitative methods may be preferred due to the ease of execution and adherence issues.

The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review

“…There is also evidence that long-term intake of high GI and glycemic load (GL) foods has consequences for metabolism and health, such as chronic hyperglycemia and hyperinsulinemia, which can lead to insulin resistance and diabetes [ 6 ]. On the low GI diet, the incidence of moderate hypoglycemia was considerably greater than on the high GI diet, suggesting that insulin doses may need to be decreased even more with low GI meals [ 23 ]. The American Diabetes Association (ADA) suggests that individuals with diabetes who have acquired expertise in CC can also be educated on the glycemic effects of protein and fat.…”

“…The relative role of the amount and type of carbohydrate in regulating the BG response to meals is a significant subject of conflict. The term "carbohydrate type" has become interchangeable with the term "glycemic index," which is a way of defining a food's glycemic effect [ 23 ].…”