Intensive insulin therapy justifies simplification of the diabetes diet: a prospective study in insulin-dependent diabetic patients

Abstract

Dietary and metabolic variables were investigated in 48 unselected, nonobese Type 1 (insulin-dependent) diabetic patients before and 3 mo after changing from (a) traditional insulin and diet therapy to (b) intensified insulin plus simplified diet therapy. HbA1c levels declined significantly from 9.04 +/- 0.25% with therapy (a) to 8.34 +/- 0.16% with therapy (b) (p less than 0.005). During (a), 58% of all patients used a personal diet plan, but only 15% of them performed food exchange according to the traditional diet prescription. Their eating habits remained unchanged during (b). Since improved metabolic control in this study could be obtained without adherence to traditional diet schedules, a simplification of the traditional diabetes diet prescription seems justified for nonobese Type 1 diabetic patients on intensified insulin therapy.

Management and efficacy of intensified insulin therapy — Starting in outpatients

“…The adequate control of body weight after the change from a strict diet to variations of food intake, which BPIT makes possible, seems to be one of the central problems of IIT. One-third of our IIT diabetics experienced an undesirable increase of body weight, which is in accordance with the results of Capper et al [3] and of other groups [17], but in contrast to those of Chantelau et al [4]. As a consequence of our results, we changed our educational program with respect to dietetics.…”

Carbohydrate and preprandial insulin determination in diabetes: a review

“…Another method is the experience‐based approach whereby patients visually approximate the carbohydrate serve, learn the BG impact of that food and adjust insulin incrementally to achieve postprandial targets. Carbohydrate portions (12 g) are used in the Diabetes Teaching and Training Program (DTTP) 4,24–26 a five‐day intensive group course where patients change from conventional therapy (twice daily insulin and irregular monitoring) to MDI and frequent daily BG monitoring (BGM). An ICR is used to help determine doses and GI information is provided 4 .…”

“…While this minimised extremes in blood glucose (BG) excursions, there was little room for variation according to appetite, illness or desired food choices. Many patients on these regimes thought their diet was inflexible, restrictive and hard to incorporate into daily life 4 . Intensive insulin regimes are now commonplace, using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII or the ‘insulin pump’).…”

“…This involves the administration of short‐acting insulin before meals and longer acting insulin (or continuous infusion with the pump) to cover basal insulin requirements. Intensive regimes allow patients to have a liberalised diet with equal or improved glycaemic control 4–6 . However, there are several methods of determining preprandial insulin dose especially with variable food/carbohydrate intake.…”

Non-Evidence-Based Concepts Are Still Established in the Treatment of IDDM

“…It has been shown repeatedly that in patients with adequate preprandial insulin therapy the inclusion of sucrose in a mixed meal does not lead to a significant postprandial hyperglycemia [20, 21, 22, 23]. Even regular use of up to 40 g sucrose/day in the nutrition of intensively treated IDDM patients had no negative effect on metabolic control [24, 25, 26, 27]. …”