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All meal trays come with a list of the carbohydrate content for each item, and nurses are trained to administer insulin based on carbohydrate intake.
The American Diabetes Association advocates insulin regimens for youth with type 1 diabetes that involve adjusting insulin dose based on carbohydrate intake and blood glucose level.
A study of 126 patients with refractory hyperglycemia or requiring at least 20 U/day insulin were randomized to either meals with a standard amount of carbohydrates accompanied by fixed dosing, or flexible dosing based on carbohydrate intake [ 148].
To help optimize glycemic control in youth with type 1 diabetes, the American Diabetes Association therefore advocates intensive insulin regimens in which insulin doses are calculated based on carbohydrate intake and blood glucose level (2, 3).
The Diabeo system helps diabetic patients by calculating bolus insulin dose based on carbohydrate intake, pre-meal blood glucose, and anticipated physical activity reported; and automatically adjusts carbohydrate ratio and basal insulin.
Both groups received insulin lispro before each meal based on carbohydrate intake, with individualized correction doses based on the degree to which blood glucose levels deviated from the target glucose values.
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A unifying focus of nutrition therapy interventions for type 2 diabetes is a reduced energy intake and, for type 1 diabetes, adjusting insulin based on carbohydrate counting.
For individuals with type 1 diabetes using multiple daily injections or continuous subcutaneous insulin infusion, a primary focus for nutrition therapy should be on how to adjust insulin doses based on planned carbohydrate intake (13, 39, 43, 50– 50).
For example, a patient with diabetes may need numeracy to calculate their carbohydrate intake and adjust their insulin based on carbohydrates and/or current blood glucose level.
All nurses at the study institution are trained on dosing based upon carbohydrate intake, but additional interventions to ensure dosing accuracy appear to be necessary, regardless of the method of bolus insulin dosing.
An alternative approach is to administer prandial insulin based upon carbohydrate intake.
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