Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-27

insulin secretagogues are also at risk of hypoglycemia if a mealtime is delayed. Those who do not take insulin or oral agents do not have to pay strict attention to specific meal timing.

Consistency of carbohydrate intake Carbohydrate consistency refers to the amount of carbohydrate eaten at a specific time, from day to day. An example would be the amount of carbohydrate eaten at breakfast today, compared to breakfast tomorrow (not the amount of carbohydrate eaten at breakfast compared to lunch; that would represent carbohydrate distribution). SMBG and flexible insulin regimens now allow for greater latitude in meal planning for those who use insulin. However, regardless of the sophistication of the insulin regimen, it still cannot mimic the precise response of the pancreas, and insulin doses can only be estimated. Consistency in carbohydrate intake (104), as well as spacing and regularity in meal consumption, may help control BG levels (104-106). Results of the Diabetes Control and Complications Trial (DCCT) revealed that participants in the intensive-therapy group showed a significant association between lower A1C and greater consistency in food intake (107,108). However, if patients prefer to have more flexibility in their carbohydrate intake, they should adjust their insulin based on the carbohydrate content of their meals and snacks. Glycemic control and quality of life can be improved when people who take rapid-acting insulin receive education on matching insulin to carbohydrate content (109-110) (“carbohydrate counting”) (see Chapter 12: Basal-Bolus Insulin Therapy). For those who use fixed daily insulin doses (example: 30/70 BID) or pills that can cause hypoglycemia, carbohydrate consistency is important. As with distribution of carbohydrates, these people have less flexibility than those using multiple daily insulin injections because their pancreas is not able to adapt to a larger glycemic load; a carbohydrate intake that is higher than usual will result in hyperglycemia. Conversely, if less carbohydrate is eaten, there is the risk of hypoglycemia. For those who take medication that does not cause hypoglycemia, or those who take no medication to manage their BG, consistent carbohydrate is not crucial as long as sufficient carbohydrate is consumed and not too much is consumed at one time. Amount of carbohydrate/weight gain Weight gain has been found to be an undesired side effect of improved glycemic control when certain medications are initiated (see Chapter 6: Treatment Modalities: Pharmacological Therapies), but is most evident when a patient begins intensive therapy (111). There are