What is an insulin: CHO ratio (ICR)? Rachel's physician ordered ...

[sc00by25]

What is an insulin: CHO ratio (ICR)? Rachel's physician ordered her ICR to start at 1:15 . If her usual breakfast is 2 Pop-Tarts and 8 oz. skim milk, how much Apidra should she take to cover the carbohydrate in this meal?
 
  What will be an ideal response?

Question 2

Determine Rachel's initial nutrition prescription using her usual intake at home as a guideline, as well as your assessment of her energy requirements.
 
  What will be an ideal response?

[dellikani2015]

Answer to Question 1

An insulin: CHO ratio is an individualized ratio that specifies how many grams of carbohydrate one unit of insulin will cover. It can be determined by dividing 500 by the total daily insulin dose (TDD) of that person.
2 Pop-Tarts = 76 grams CHO
8 oz. skim milk = 12 g CHO
Total: 88 grams CHO/15 = 5.8 or 6 units to cover this meal

Answer to Question 2

Carbohydrate needs based on 45-65 of total kcal from CHO:
2400 x 0.45 = 1080 kcal/4 kcal/g = 270 grams CHO/d/15 grams/serving = 18 servings/day
2400 x 0.65 = 1560 kcal/4 kcal/g = 390 grams CHO/d/15 grams/serving = 26 servings/day
Current meals/snacks consumed: Breakfast, lunch, dinner, and a snack before soccer practice
Nutrition prescription:
90 grams CHO for breakfast, lunch, and dinner (6 CHO equivalents/meal)
30 grams CHO (2 CHO equivalents) for snacks, twice per day (one mid-morning and one before soccer practice or other physical activity)
It is typical in pediatric practice to not prescribe a certain amount of CHO. It is more important for the patient to understand the insulin: CHO ratio and cover her intake accordingly.

[sc00by25]

Both answers were spot on, thank you once again

[dellikani2015]

Great! Please up vote