Abstract | BACKGROUND: To optimize insulin dose using insulin pump, basal and bolus insulin doses are widely calculated from total daily insulin dose ( TDD). It is recommended that total daily basal insulin dose (TBD) is 50% of TDD and that the carbohydrate-to- insulin ratio (CIR) equals 500 divided by TDD. We recently reported that basal insulin requirement is approximately 30% of TDD. We therefore investigated CIR after adjustment of the proper basal insulin rate. SUBJECTS AND METHODS: Forty-five Japanese patients with type 1 diabetes were investigated during several weeks of hospitalization. The patients were served standard diabetes meals (25-30 kcal/kg of ideal body weight). Each meal omission was done to confirm basal insulin rate. Target blood glucose level was set at 100 and 150 mg/dL before and 2 h after each meal, respectively. After the basal insulin rate was fixed and target blood glucose levels were achieved, TBD, CIR, TDD, and their products were determined. RESULTS: Mean (±SD) blood glucose levels before and 2 h after meals were 121±47 and 150±61 mg/dL, respectively. TDD was 31.5±9.0 U, and TBD was 27.0±6.5% of TDD. CIR×TDD of breakfast was significantly lower than those of lunch and supper (288±73 vs. 408±92 and 387±83, respectively; P<0.01). CONCLUSIONS: CIR has diurnal variance and is estimated from the formula CIR=300/ TDD at breakfast or CIR=400/ TDD at lunch and supper in type 1 diabetes patients. These results indicate that the insulin dose has been underestimated by using previously established calculations.
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Authors | Akio Kuroda, Tetsuyuki Yasuda, Mitsuyoshi Takahara, Fumie Sakamoto, Ryuichi Kasami, Kazuyuki Miyashita, Sumiko Yoshida, Eri Kondo, Ken-ichi Aihara, Itsuro Endo, Taka-aki Matsuoka, Hideaki Kaneto, Toshio Matsumoto, Iichiro Shimomura, Munehide Matsuhisa |
Journal | Diabetes technology & therapeutics
(Diabetes Technol Ther)
Vol. 14
Issue 11
Pg. 1077-80
(Nov 2012)
ISSN: 1557-8593 [Electronic] United States |
PMID | 23101953
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Blood Glucose
- Carbohydrates
- Glycated Hemoglobin A
- Hypoglycemic Agents
- Insulin
- hemoglobin A1c protein, human
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Topics |
- Adult
- Aged
- Basal Metabolism
(drug effects)
- Blood Glucose
(drug effects, metabolism)
- Blood Glucose Self-Monitoring
- Carbohydrates
(blood)
- Diabetes Mellitus, Type 1
(blood, drug therapy)
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Glycated Hemoglobin
(drug effects, metabolism)
- Humans
- Hypoglycemic Agents
(administration & dosage)
- Infusion Pumps, Implantable
- Insulin
(administration & dosage)
- Japan
- Male
- Meals
- Middle Aged
- Time Factors
- Young Adult
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