Improving the Estimation of Meal-Time Insulin Dose Based On the Glycaemic Load of a Meal in Children with Type 1 Diabetes on Insulin Pump Therapy: A Randomized Study

Functional Insulin Therapy (FIT) reduces the risk of diabetic late complications, improves the quality of treatment as well the quality of life, and is a recommended method for treating Type 1 Diabetes (T1D) patients [1,2]. In terms of postprandial glucose control, meal insulin dosage based on carbohydrate counting, the ‘golden standard’ in FIT, is unsatisfactory probably due to many factors influencing postprandial glucose excursion. Food counting and the exchange system in which grams of carbohydrates are expressed as a unit of bread were introduced several years ago [3]. This system is not always sufficiently effective. Therefore, factors other than only carbohydrate grams are considered in meal insulin adjustment. According to the American Diabetes Association (ADA) both Glycaemic Load (GL) and Glycaemic Index (GI) should be considered when choosing carbohydrate products [1]. Glycaemic Load (GL), apart from the glycaemic index, takes into account carbohydrate content in the meal. Although products with high glycaemic load are not recommended for children, due to their physiological development, children need to consume carbohydrate meals which can be easily and quickly absorbed. Unfortunately, the availability of fast food makes it easy for children to consume this type of meal far too often. It is also difficult to limit the consumption of such products among children with type 1 diabetes, especially among small children who have a tendency to consume easily absorbed carbohydrate products [4,5].