Dorota Pisarczyk-Wiza

Assessment of adherence to the dietary recommendations concerning the amount of carbohydrates intake in type 1 diabetic patients treated with continuous subcutaneous insulin infusion during pregnancy and 8 weeks after the delivery

Introduction . Pregnancy in type 1 diabetic women isa special period requiring intensified care performedby the multidisciplinary therapeutic team. Maintainingthe recommended rigorous glycemic control is crucialcondition for the correct development of the foetus,and the mother’s health. The menu of pregnant diabeticpatients should provide them with all essentialdiet nutrients. Among them, carbohydrates affectblood glucose level the most strongly. Not only theiramount, but also type and distribution are important. Material and methods . The study group consisted of32 pregnant women with type 1 diabetes. All patientswere treated with intensive insulin therapy with theuse of continuous subcutaneous insulin infusion (CSII).In all cases we evaluated: glycated hemoglobin (HbA1c),body weight, daily intake of carbohydrates, the adherenceto the dietary recommendations concerning theamount of carbohydrates intake (per day) — at thetime of diagnosis of pregnancy, in 24th and 36th weekof pregnancy as well as 8 weeks after childbirth. Therecommended carbohydrate intake was calculated individuallyfor each patient and accounted for 40–45%of the daily energy demand. The consumption of therecommended amount of carbohydrates was assessedas 100% adherence. The information about carbohydrateintake in each trimester and after childbirth,was obtained from the computer program used toread data from the personal insulin pump and frompatients self-monitoring diaries. Results . Recommended daily carbohydrate intake forthe entire study group was approx. 205.6 ± 34.2 g ofcarbohydrates. The adherence to the recommendationsassessed in 1st, 2nd and 3rd trimester and 8 weeks afterchildbirth was: 82.8 ± 28.3%, 91.1 ± 29.7%, 97.3 ±± 34.8%, 69.9 ± 32.6%, respectively (p < 0.00001).After birth, breastfeeding subjects consumed 60.2 ±± 24.5% of the recommended carbohydrate intake,while for non-breastfeeding subjects it was 91.4 ±± 38.9% (p = 0.01). Subjects with normal body weightbefore pregnancy followed the recommendation inthe 1st, 2nd and 3rd trimester and 8 weeks after birthin 73.4 ± 19.9%, 83.4 ± 23.7%, 91.2 ± 30.2%, 63.4 ±± 25.3%, respectively, while overweight subjects in111.0 ± 32.1%, 114.5 ± 34.9%, 115.8 ± 42.9%, 89.8 ±± 44.7%, respectively. Conclusion . Pregnant type 1 diabetic women withnormal body weight before pregnancy consumedless carbohydrates than recommended. Complianceconcerning dietary recommendations significantly differedin particular trimesters and 8 weeks after birth.We observed a statistically significant decrease in theadherence to the recommendation after pregnancy.Breastfeeding subjects consumed less carbohydratesthan non-breastfeeding. Overweight subjects consumedmore carbohydrates than recommended.

The proposal of initial bolus calculator settings in Accu-Chek Combo system

Bolus calculator feature (BC) is one of the most important options of modern insulin pumps. It enables both periprandial as well as correction insulin dosing. BC function leads to improvement of patient’s metabolic control. It makes the treatment safer andlimits the number of hypoglycemic episodes. In presented article we propose preliminary setting of BC in the Accu-Chek Combo system. It is obvious that those setting should be always verified according to a clinical situation.