Israel Medical Association Journal

Background: Carbohydrate counting (CC), a recommended method for managing insulin bolus in patients with Type 1 diabetes mellitus (T1DM), depends on patient cognitive ability and motivation, and often does not account for ethnic foods. We have developed a simplified, accessible, patient-specific carbohydrate counting tool (SCC) to serve our very diverse population.

Objective: To retrospectively evaluate the long-term efficacy of the SCC with an emphasis on patients with moderate to poor glycemic control.

Method: The SCC tool is tailored to each patient’s insulin:carbohydrate ratio (I:C), insulin sensitivity (IS), and dietary pattern. It includes two tables written in the patient's preferred language. The first lists the units of insulin needed to correct pre-meal blood glucose to target glucose. The second contains a list of food items derived from participant's personal eating habits, carbohydrate content, and the number of insulin units needed.

At a median follow-up period of 6 months, we examined the change in hemoglobin A1c (HbA1c) in 212 patients with T1DM who utilized the SCC.

Results: At follow-up, HbA1c in the study population decreased by 1.07% (22.43 mmol/mol) (95% confidence interval 0.8–1.3, P < 0.001). The variables sex and diabetes duration were nearly statistically significant in relation to the change in HbA1c levels (P = 0.059, P = 0.056).

Conclusions: While not influenced by age, sex, ethnicity, socioeconomic status, education, insulin delivery method, duration of diabetes, or residence, the SCC tool is designed to help adult patients with T1DM with moderate to poor glycemic control.

Background: Carbohydrate malabsorption of lactose, fructose and sorbitol has already been described in normal volunteers and in patients with functional bowel complaints including irritable bowel syndrome. Elimination of the offending sugar(s) should result in clinical improvement.

Objective: To examine the importance of carbohydrate malabsorption in outpatients previously diagnosed as having functional bowel disorders, and to estimate the degree of clinical improvement following dietary restriction of the malabsorbed sugar(s).

Methods: A cohort of 239 patients defined as functional bowel complaints was divided into a group of 94 patients who met the Rome criteria for irritable bowel syndrome and a second group of 145 patients who did not fulfill these criteria and were defined as functional complaints. Lactose (18 g), fructose (25 g) and a mixture of fructose (25 g) plus sorbitol (5 g) solutions were administered at weekly intervals. End-expiratory hydrogen and methane breath samples were collected at 30 minute intervals for 4 hours. Incomplete absorption was defined as an increment in breath hydrogen of at least 20 ppm, or its equivalent in methane of at least 5 ppm. All patients received a diet without the offending sugar(s) for one month.

Results: Only 7% of patients with IBS and 8% of patients with FC absorbed all three sugars normally. The frequency of isolated lactose malabsorption was 16% and 12% respectively. The association of lactose and fructose-sorbitol malabsorption occurred in 61% of both patient groups. The frequency of sugar malabsorption among patients in both groups was 78% for lactose malabsorption (IBS 82%, FC 75%), 44% for fructose malabsorption and 73% for fructose-sorbitol malabsorption (IBS 70%, FC 75%). A marked improvement occurred in 56% of IBS and 60% of FC patients following dietary restriction. The number of symptoms decreased significantly in both groups (P<0.01) and correlated with the improvement index (IBS P<0.05, FC P<0.025).

Conclusions: Combined sugar malabsorption patterns are common in functional bowel disorders and may contribute to symptomatology in most patients. Dietary restriction of the offending sugar(s) should be implemented before the institution of drug therapy.

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IBS = irritable bowel syndrome

FC = functional complaints