Diabetic Case: 19-year-old Man with Type 1 DM

00:00 Let's go on to another case. A 19-year-old student athlete at a local university was recently diagnosed with type 1 diabetes mellitus. He is very motivated to ensure that he has very tight blood sugar control and comes to see you to discuss his options. His current hemoglobin A1c is 8.4%. What advice can you give this young athlete about his glucose control regimen? Based on this patient's situation and motivation to control his blood sugars very tightly, basal and bolus insulin dosing and carbohydrate counting based on meal size with tight adjustments for exercise regimens is a very good way to start his lifetime of insulin therapy. This particular patient is also a very good candidate for an insulin pump. Carbohydrate counting principles are helpful to know for all patients who are planning tight glycemic control. Due to its longer onset of action, regular insulin requires a longer time interval between prandial injection and food consumption compared with analog insulin. Carbohydrate counting with prandial analog insulin allows flexibility of the types and sizes of meals that you can consume by adjusting the dose based on the number of carbohydrates ingested. 1 unit of analog insulin usually covers somewhere in the range of 10-20 grams of a carbohydrate meal and using this information you can calculate based on how many carbohydrates you're planning on eating, how much insulin to provide yourself as a bolus dose. Modified carbohydrate counting for patients who are unwilling or unable to count carbohydrates include a fixed prandial dose of regular or analog insulin that can be adjusted by 50% based on the size of the meal, regular being 100% of dose, a small meal being half the dose, or a large meal being 150% of the dose.