Carbohydrate counting at meal time followed by a small secondary postprandial bolus injection at 3 hours prevents late hyperglycemia, without hypoglycemia, after a high-carbohydrate, high-fat meal in type 1 diabetes

Patients with type 1 diabetes are provided guidance and structured education on adjusting their mealtime bolus insulin dose based on meal carbohydrate content. However, recent research in patients using continuous subcutaneous insulin infusion has highlighted the role of dietary fat in increasing prandial insulin requirements, particularly late into the postprandial period (1,2). Many patients are treated with basal-bolus insulin injections, which is a less flexible method of insulin therapy than continuous subcutaneous insulin infusion, e.g., patients are unable to administer dual-wave/extended bolus at mealtime. It is important to consider that patients are encouraged to count carbohydrates and administer rapid-acting insulin units at mealtime and that the time-action profiles of lispro/aspart vary in a dose-dependent manner. The peak insulin concentration after a premeal bolus usually occurs within the first 60 min (3), but the peak action is usually observed between 90 and 120 min, and this duration can vary between 4 and 6 h. However, peak …