Bell Kirstine J, King Bruce R, Shafat Amir, Smart Carmel E
Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia.
Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia; Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.
J Diabetes Complications. 2015 Nov-Dec;29(8):1323-9. doi: 10.1016/j.jdiacomp.2015.08.014. Epub 2015 Aug 20.
A primary focus of the nutritional management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. Different methods exist to quantify carbohydrate including counting in one gram increments, 10g portions or 15g exchanges. Clinicians have assumed that counting in one gram increments is necessary to precisely dose insulin and optimize postprandial control. Carbohydrate estimations in portions or exchanges have been thought of as inadequate because they may result in less precise matching of insulin dose to carbohydrate amount. However, studies examining the impact of errors in carbohydrate quantification on postprandial glycemia challenge this commonly held view. In addition it has been found that a single mealtime bolus of insulin can cover a range of carbohydrate intake without deterioration in postprandial control. Furthermore, limitations exist in the accuracy of the nutrition information panel on a food label. This article reviews the relationship between carbohydrate quantity and insulin dose, highlighting limitations in the evidence for a linear association. These insights have significant implications for patient education and mealtime insulin dose calculations.
1型糖尿病营养管理的一个主要重点是使餐时胰岛素治疗与所摄入的碳水化合物量相匹配。存在不同的方法来量化碳水化合物，包括以1克增量、10克份量或15克交换份来计算。临床医生一直认为以1克增量计数对于精确调整胰岛素剂量和优化餐后血糖控制是必要的。按份量或交换份进行碳水化合物估算被认为不够准确，因为这可能导致胰岛素剂量与碳水化合物量的匹配不够精确。然而，研究碳水化合物量化误差对餐后血糖影响的研究对这一普遍观点提出了挑战。此外，还发现单次餐时胰岛素大剂量可以覆盖一定范围的碳水化合物摄入量，而不会导致餐后血糖控制恶化。此外，食品标签上营养信息面板的准确性也存在局限性。本文回顾了碳水化合物量与胰岛素剂量之间的关系，强调了线性关联证据中的局限性。这些见解对患者教育和餐时胰岛素剂量计算具有重要意义。
