Cordon NM, Smart CEM, Smith GJ, et al. - There was a non-linear association between insulin requirement and breakfast carbohydrate content, implying that there is a need for a strengthened insulin-to carbohydrate ratio for meals with ≤20 and ≥150 g of carbohydrate. It has been considered that meals with ≥150 g of carbohydrate may benefit from dual wave bolusing.

• Researchers designed an open-labeled randomized four-arm cross-over study including a total of 31 individuals aged 12–27 years.

• The results indicated that 20 g carbohydrate breakfast had the largest proportion of time in the range (0.74 ± 0.29 p < 0.04).

• In comparison with the 20 g (n = 6, 20%) and 150 g (n = 7, 26%) breakfasts (p < 0.029), hypoglycemia was more frequent in the 50 g (n = 13, 42%) and 100 g (n = 15, 50%) breakfasts.

• The findings revealed that the 150 g breakfast glucose excursion pattern was different from the smaller breakfasts with the lowest glucose excursion 0–2 h and the highest excursion from 3.5 to 5 h.