How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?
How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?
Objective: In this study, it was aimed to evaluate the effects of an additional insulin dose for high-fat and high-protein meal on blood glucose levels in adolescents with type 1 diabetes. Patients and Methods: This study was single-center, crossover, and randomized. Seven adolescents with type 1 diabetes between the ages of 14 and 17 were given breakfast containing high-fat (45.9% energy) and high-protein (21.9% energy) for two consecutive days, and two different insulin doses were administered. According to the first application dose of carbohydrate/insulin ratio, the second application was given this dose of additional insulin up to 30% in postprandial 180th minute. Blood glucose was monitored for 360 minutes at 30-minute intervals using a continuous glucose monitoring system (CGMS). Results: The average time spent in the target range (TIR) of participants was 30.6±11.83%, and time spent in hyperglycemia and hypoglycemia (time above range (TAR) and time below range (TBR)) were 67.0±14.31% and 2.4±4.89%, respectively. There was no statistically significant difference between the early (0-120th min), late (120-360th min), and total (0-360th min) glycemic responses of the applications (p>0.05). According to CGMS result, mean blood glucose, glycemic variability, and absolute blood glucose difference median and mean absolute deviation (MAD%) were found to be similar after two applications (p>0.05). Conclusion: Insulin dose applications should be individually calculated to prevent delayed-prolonged postprandial hyperglycemia caused by high-fat high – protein intake in adolescents with type 1 diabetes.
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- [1] Bluestone JA, Herold K, Eisenbarth G. Genetics, pathogenesis
and clinical interventions in type 1 diabetes. Nature 2010;
464:1293-300. doi: 10.1038/nature08933
- [2] Cameron FJ, Garvey K, Hood KK, et al. ISPAD clinical practice
consensus guidelines 2018: diabetes in adolescence. Pediatr
Diabetes 2018; 19:250-61. doi: 10.1111/pedi.12702.
- [3] American Diabetes Association. 6. Glycemic targets: standards
of medical care in diabetes-2020. Diabetes Care 2020; 43:S1-
224. doi: 10.2337/dc20-S006.
- [4] American Diabetes Association. 4. Lifestyle management:
standards of medical care in diabetes-2018. Diabetes Care
2018; 41:S38-50. doi: 10.2337/dc18-S004.
- [5] Brazeau A, Mircescu H, Desjardins K, et al. Carbohydrate
counting accuracy and blood glucose variability in adults with
type 1 diabetes. Diabetes Res Clin Pract 2013; 9919-23. doi:
10.1016/j.diabres.2012.10.024.
- [6] Mehta SN, Quinn N, Volkening LK, et al. Impact of
carbohydrate counting on glycemic control in children with
type 1 diabetes. Diabetes Care 2009; 32:1014-6. doi: 10.2337/
dc08-2068.
- [7] Pańkowska E, Błazik M, Groele L. Does the fat-protein
meal increase postprandial glucose level in type 1 diabetes
patients on insulin pump: the conclusion of a randomized
study. Diabetes Technol Ther 2012; 14:16-22. doi: 10.1089/
dia.2011.0083.
- [8] Peters AL, Davidson MB. Protein and fat effects on glucose
responses and insulin requirements in subjects with insulindependent
diabetes mellitus. Am J Clin Nutr 1993; 58:555-60.
doi: 10.1093/ajcn/58.4.555.
- [9] Smart CE, Evans M, O’connell SM, et al. Both dietary protein
and fat increase postprandial glucose excursions in children
with type 1 diabetes, and the effect is additive. Diabetes Care
2013; 36:3897-902. doi: 10.2337/dc13-1195.
- [10] Wolpert HA, Atakov-Castillo A, Smith SA, et al. Dietary
fat acutely increases glucose concentrations and insulin
requirements in patients with type 1 diabetes: implications
for carbohydrate-based bolus dose calculation and intensive
diabetes management. Diabetes Care 2013; 36:810-6. doi:
10.2337/dc12-0092.
- [11] Kordonouri O, Hartmann R, Remus K, et al. Benefit of
supplementary fat plus protein counting as compared
with conventional carbohydrate counting for insulin bolus
calculation in children with pump therapy. Pediatr Diabetes
2012; 13:540-4. doi: 10.1111/j.1399-5448.2012.00880.x.
- [12] Paterson M, Bell KJ, O’Connell SM, et al. The role of dietary
protein and fat in glycaemic control in type 1 diabetes:
implications for intensive diabetes management. Curr Diab
Rep 2015; 15:61. doi: 10.1007/s11892.015.0630-5.
- [13] Piechowiak K, Dżygało K, Szypowska A. The additional
dose of insulin for high‐protein mixed meal provides better
glycemic control in children with type 1 diabetes on insulin
pumps: randomized cross‐over study. Pediatr Diabetes 2017;
18:861-8. doi: 10.1111/pedi.12500.
- [14] Bloomgarden Z. Beyond HbA1c. J Diabetes 2017; 9:1052. doi:
10.1111/1753-0407.12590.
- [15] Rama Chandran S, Tay WL, Lye WK, et al. Beyond HbA1c:
comparing glycemic variability and glycemic indices in
predicting hypoglycemia in type 1 and type 2 diabetes. Diabetes
Technol Ther 2018; 20:353-62. doi: 10.1089/dia.2017.0388.
- [16] Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation
of time in range as an outcome measure for diabetes clinical
trials. Diabetes Care 2019; 42:400-5. doi: 10.2337/dc18-1444.
- [17] Vigersky RA, McMahon C. The relationship of hemoglobin
A1C to time-in-range in patients with diabetes. Diabetes
Technol Ther 2019; 21:81-5. doi: 10.1089/dia.2018.0310.
- [18] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets
for continuous glucose monitoring data interpretation:
recommendations from the international consensus on time
in range. Diabetes Care 2019; 42:1593-603. doi: 10.2337/
dci19-0028.
- [19] Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J,
et al. Eating problems in adolescents with Type 1 diabetes:
a systematic review with meta‐analysis. Diabet Med 2013;
30:189-98. doi: 10.1111/j.1464-5491.2012.03771.x.
- [20] Abdou M, Hafez MH, Anwar GM, et al. Effect of high protein
and fat diet on postprandial blood glucose levels in children
and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes
Metab Syndr 2021; 15:7-12. doi: 10.1016/j.dsx.2020.11.020.
- [21] Keating B, Smart CEM, Harray AJ, et al. Additional insulin
is required in both the early and late postprandial periods
for meals high in protein and fat: a randomized trial. J Clin
Endocrinol Metab 2021; 106: e3611-8. doi: 10.1210/clinem/
dgab318.
- [22] Roden M, Price TB, Perseghin G, et al. Mechanism of free fatty
acid-induced insulin resistance in humans. J Clin Investig
1996; 97:2859-65. doi: 10.1172/JCI118742.
- [23] Bell K, Gray R, Munns D, et al. Estimating insulin demand for
protein-containing foods using the food insulin index. Eur J
Clin Nutr 2014; 68:1055-9. doi: 10.1038/ejcn.2014.126.
- [24] Bell KJ, Smart CE, Steil GM, et al. Impact of fat, protein, and
glycemic index on postprandial glucose control in type 1
diabetes: implications for intensive diabetes management in
the continuous glucose monitoring era. Diabetes Care 2015;
38:1008-15. doi: 10.2337/dc15-0100.
- [25] Bell KJ, Toschi E, Steil GM, et al. Optimized mealtime insulin
dosing for fat and protein in type 1 diabetes: application of a
model-based approach to derive insulin doses for open-loop
diabetes management. Diabetes Care 2016; 39:1631-4. doi:
10.2337/dc15-2855.
- [26] Pańkowska E, Błazik M. Bolus calculator with nutrition
database software, a new concept of prandial insulin
programming for pump users. J Diabetes Sci Technol 2010;
4:571-6. doi: 10.1177/193.229.681000400310.
- [27] Pańkowska E, Szypowska A, Lipka M, et al. Application of novel
dual wave meal bolus and its impact on glycated hemoglobin
A1c level in children with type 1 diabetes. Pediatr Diabetes
2009; 10:298-303. doi: 10.1111/j.1399-5448.2008.00471.x.
- [28] Mendes RH, Hagen MEK, Barp J, et al. Isolated soy proteinbased
diet ameliorates glycemia and antioxidants enzyme
activities in streptozotocin-induced diabetes. FNS 2014;
5:2089-96. doi: 10.4236/fns.2014.521221.
- [29] Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends
for childhood type 1 diabetes in Europe during 1989–2003
and predicted new cases 2005–20: a multicentre prospective
registration study. Lancet 2009; 373:2027-33. doi: 10.1016/
S0140-6736(09)60568-7.
- [30] Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive
oil reduces glycemic response to a high–glycemic index meal
in patients with type 1 diabetes: a randomized controlled trial.
Diabetes Care 2016; 39:518-24. doi: 10.2337/dc15-2189.
- [31] Maffeis C, Morandi A, Ventura E, et al. Diet, physical, and
biochemical characteristics of children and adolescents with
type 1 diabetes: relationship between dietary fat and glucose
control. Pediatr Diabetes 2012; 13:137-46. doi: 10.1111/j.1399-
5448.2011.00781.x.