Self-Management of Insulin in type I diabetic patients

Abstract

Flexible intensive insulin therapy (FIT) permits the patient to adjust the timing and the amount of insulin administered by using long-acting insulin which is injected once or twice daily and rapid acting insulin which is taken according to carbohydrate intake. This therapy allows patients to have greater dietary flexibility. The aims was to assess the impact of insulin therapy adjustments according to carbohydrate counting on HbA1c control among patients diagnosed with type 1 diabetes. A self-administered Carbohydrate Counting Assessment Questionnaire (CCAQ) was adapted from ‘The Heart Healthy Carb Quiz’ and ‘The Stanford Patient Education Research Centre Diabetes Questionnaire’. The CCAQ was validated by an expert panel consisting of (1 diabetologist, 2 pharmacists, 1 diabetic nurse specialist and 1 diabetic educator). The study took place during an 8-week period from October to November 2016. Patients were chosen by convenience sampling and asked to complete the CCAQ. Two groups of patients completed the questionnaire; one group was taking insulin according to carbohydrate counting (Group 1) and the other group was on conventional insulin therapy (Group 2). Forty patients (22 male, 18 female; mean age 40 years; range 16-66 years) were in Group 1 and 40 patients (11 male, 29 female; mean age 36 years; range 14-65 years) were in Group 2. When the HbA1c values of the two patient groups were compared, the mean HbA1c value of patients in group 1 (8.09%) was significantly lower (p=0.02) than the mean HbA1c value of patients in group 2 (8.73%). Patients who were taking insulin according to the carbohydrate count had better glycaemic control than patients on conventional insulin therapy. The application of carbohydrate counting and flexible and intensive insulin therapy provide an advantageous outcome in glycaemic control.