Lidia Groele, Dominik Golicki, Marlena BÅazik and Ewa PaÅkowska
Background: The aim of the study was to assess whether an Insulin-Carbohydrate Ratio (ICR) increased by 30% per meal with a high glycaemic load allows postprandial glucose excursion to be maintained in control in children with type 1 diabetes.
Methods: A total of 70 children on insulin pump therapy participated in the study. They were stratified into age groups: 4-7 years of age, 8-12 years of age and above 12 years of age. The experimental Group (A) received an insulin dose based on individualised ICR increased by 30% for breakfast containing cornflakes with milk. The control group (B) received an insulin dose based on standard individualised ICR. The glycaemic load of the meal was adjusted to the age group (24,3; 32,4; 40,5). We assessed metabolic effects such as the area under the glucose curve (AUC), glucose increment, risk of hyperglycaemia and hypoglycaemia using two methods: blood glucose concentration (at 0, 15, 30, 45, 60, 90 and 120 minutes) and a continuous subcutaneous glucose measurement system (for 3 hours postprandially).
Results: A significant glucose rise was noted in the control group B (p=0.03). Over the postprandial 180 minutes, AUC was significantly lower (p=0.02) in the experimental group but only in children aged 8-12. The frequency of hypoglycaemic events was not statistically significant during postprandial observation (p=0.75).
Conclusion: Increasing the ICR by 30% for a meal with high GL can reduce the glucose excursion without increasing the risk of hypoglycaemia in children with type 1 diabetes treated with insulin pump therapy.