Which factor is used to guide insulin-to-carbohydrate ratio (ICR) adjustment after the initial 500-rule estimate?

Which factor is used to guide insulin-to-carbohydrate ratio (ICR) adjustment after the initial 500-rule estimate?

• A. Body mass index
• B. Total daily carbohydrate intake
• C. Postmeal glucose measurements
• D. Fasting glucose measurements

Answer: (C)

Postmeal glucose measurements provide the direct feedback needed to fine-tune the insulin-to-carbohydrate ratio after the starting estimate. The 500-rule gives a starting point for how many grams of carbohydrate one unit of rapid-acting insulin covers, based on total daily insulin. But individual response to meals varies due to factors like meal composition, activity, and insulin action. By checking postprandial glucose, you see whether the bolus insulin is delivering enough or too much per gram of carbohydrate. If postmeal values are consistently high, you increase the ratio (more units per carbohydrate); if they’re too low, you decrease it. BMI and total daily carbohydrate intake don’t guide this ongoing adjustment, and fasting glucose reflects basal needs rather than meal insulin adequacy.

Postmeal glucose measurements provide the direct feedback needed to fine-tune the insulin-to-carbohydrate ratio after the starting estimate. The 500-rule gives a starting point for how many grams of carbohydrate one unit of rapid-acting insulin covers, based on total daily insulin. But individual response to meals varies due to factors like meal composition, activity, and insulin action. By checking postprandial glucose, you see whether the bolus insulin is delivering enough or too much per gram of carbohydrate. If postmeal values are consistently high, you increase the ratio (more units per carbohydrate); if they’re too low, you decrease it.

BMI and total daily carbohydrate intake don’t guide this ongoing adjustment, and fasting glucose reflects basal needs rather than meal insulin adequacy.