Optimizing a prandial insulin dosing in patients with type 1 diabetes

Abstract

Intensive functional insulin therapy (FIT) relies on an algorithm for counting carbohydrate exchanges (CE) developed in the 1980s. With this method, patients with type 1 diabetes can tailor an insulin dose themselves depending on the amount of carbohydrates taken with food. However, it has been proven that proteins and fats affect the level of after-meal glycaemia and insulin secretion. This is caused by such factors as delayed gastric emptying and the involvement of proteins and fats in gluconeogenesis. To consider proteins and fats taken in meals, the concept of protein and fat exchanges (PFE) has been developed, which can be taken into account when calculating a prandial insulin dose. The aim of this paper is to explain various methods for intensive insulin therapy in patients with type 1 diabetes, treated either with continuous subcutaneous insulin infusion or with multiple dose injection.