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Time Food consumed Portion size

Number of

carbohydrate

choices

Carbohydrate (g) from

label or online source for

PORTION YOU CONSUMED

Units of rapid-acting

insulin for this meal/

snack (ICR 1:15)

9:00 Blueberry PopTarts 2 pastries (100 g) 4 72 g

Water 2 cups 0 0 g

Total: 4 Units: 5

12:00 Tyson grilled chicken breast fillet 2 strips (196 g) 0 4 g

Ore Ida crisper fries 22 pieces (84 g) 2 24 g

Medium strawberries 5 berries (60 g) 0 5 g

Water 3 cups 0 0 g

Total: 2 Units: 3

3:20 Nature Valley yogurt granola bar 1 bar (35 g) 2 26 g

Water 1.5 cups 0 0 g

Total: 2 Units: 2

7:30 Lean Cuisine baked chicken 1 meal (8.6 oz) 2 30 g

Peanut butter 2 tbsp (36 g) 1 13 g

Medium apple 1 apple (182 g) 2 25 g

Baked potato with skin and salt 1 spud (58 g) 2 27 g

Butter 1 tbsp (14.2 g) 0 0.01 g

Water 3 cups 0 0 g

Total: 7 Units: 6.5

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Questions:

1. Consider how you would need to modify your intake (as you recorded on the food record)if

you were prescribed mixed dose NPH/regular insulin twice a day at 7:30 a.m. and 5 p.m. and

were following a consistent carbohydrate intake plan. How would timing be different? What

would your carbohydrate intake need to look like from one day to the next?

I would modify my diet by not eating so many carbohydrates at night and try to balance mycarbs more throughout the day so that I do not have too much or too little.Since NPH/regular

insulin works best if injected 30 minutes prior to a meal, then I would have to change my

breakfast and dinnertime. I would have to eat my breakfast at 8:00 am rather than 9:00 and

would have to eat my dinner at 5:30 instead of at 7:30. I would need to have consistent

carbohydrate count from day to day to make sure I have a constant flow of insulin and do not

have huge spike or not enough.

2. If you were taking Lantus once a day and also taking fixed doses of mealtime rapid-acting

insulin (3 units at breakfast, 3 at lunch, 4 at supper, 1 with each snack) how would you need to

modify your dietary intake from the day you recorded to suit your insulin regimen? (Note: This

type of regimen allows a bit of flexibility with the timing, but the insulin dose does not change).

To receive 3 units at breakfast time, I would need to decrease my carbohydrate intake from

72 grams to 45 grams. Instead of eating 2 PopTarts, then I would only eat 1 which is a little

more than 45 grams which would be the right amount for me to have 3 units of insulin. At

lunch, I would need to increase my carb intake from 33 grams to 45 grams. If I ate a couple

more strawberries then this would increase my amount of carbohydrates. For dinner, I would

need to decrease the amount of carbohydrate I eat from 95 grams to 60 grams. This would

require me to not eat the apple and peanut butter unfortunately even though they would be

healthier for me than the potato. For my snack, I would have to decrease the amount of

carbohydrates from 26 grams to 15 grams since I am only getting 1 unit of insulin. This would

require me to only eat half of the Nature Valley bar.

3. Which of the three insulin regimens do you prefer and why?

Of these three different regimens, I would prefer to use Lantus with also the fixed doeses of

mealtime rapid-acting insulin. I have a very scattered class schedule and also volunteer

several times throughout the week so if I used NPH/regular insulin it would be a hassle for

me to plan and eat my meals at certain times.

4. Pick any one of your eating episodes from the day you recorded. Say your pre-prandial blood

glucose before this meal or snack was 180 mg/dL and your pre-prandial glucose target is 70-130

mg/dL. For that eating episode, what would your TOTAL insulin dose need to be? Assume atypical insulin correction factor and explain your response.

My total insulin dose would be 4 units. I first need to calculate an insulin dose for food, which

is 2. Then I use the correction factor to reach my target blood glucose, 2 units of insulin will

bring blood glucose of 180 mg/dL to 110 mg/dL. Lastly I add the insulin needed for carbs to

the insulin to correct high blood glucose, 2 units for food plus 2 units for corrections which is

4 total.

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5. What did you find most challenging about the CHALLENGE (if anything)? What did you learn

that helped to further your understanding of diabetes?

I found it challenging to be able to count the exact amount of carbohydrates that I had eaten

and the correct amount of insulin needed. I also found it challenging to remember what I had

eaten that day and write it down. I learned that it is important to keep up with the

carbohydrates eaten each day so that you can inject the correct dosage of insulin needed. Ialso have so much more respect for those who are affected with diabetes. It is a lot of work

to keep up with the dosage amount as well as food.