As two major types of diabetes (1 and 2) differ, so the use of insulin differs for each. As described earlier, in type 1 diabetes the insulin doses must be closely matched to the meals ingested. Too much insulin or too little ingested carbohydrate can cause serious hypoglycemia. Frequently, patients are on intensive insulin regimens, sometimes four doses per day, and sometimes using an insulin pump. People with well-controlled type 1 diabetes have usually learned to pay close attention to their carbohydrate intake, recognize portion sizes, or even count grams of carbohydrate. They often adjust insulin dose or carbohydrate intake, but this can be done effectively only if they have a good, quantitative understanding of both. Meals skipped or eaten late can be a problem.

Intensive insulin regimens may involve the use of an insulin pump or insulin doses based on a 'sliding scale.' Ordinarily, sliding scales are developed for the patient based on the self-monitored blood glucose at the time of the meal. For higher blood glucose levels, more short-acting insulin is administered. In more intensive regimens, often with insulin pump use, the amount of insulin delivered is also adjusted depending on both blood glucose level at the time and the carbohydrate to be ingested. To be safe and effective, this self-adjusted fine-tuning of insulin dose requires considerable knowledge of diet as well as insulin.

Examples of sliding scales are provided in Table 8. Some people, particularly those with intensive insulin regimens, learn to adjust their insulin dose according to both the blood glucose at the start of a meal and the estimated amount that a unit of insulin will reduce their blood glucose. Examples are provided in Table 9. Also, although nutritionists do not usually prescribe changes in insulin dosage, it is useful to know the various types of insulin available (Table 10) and patterns of insulin action (Figure 1).

With type 2 diabetes, since there is usually some insulin secreted on demand from the pancreas and considerable resistance to insulin, dietary intake may not have to be so precisely regulated according to insulin dose. There is a risk of hypoglycemia but it is usually less than that seen in type 1 diabetes. As discussed previously, the nutritional emphasis is usually on reducing the caloric intake, with careful control of fat as well as carbohydrate.

Delicious Diabetic Recipes

Delicious Diabetic Recipes

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