High-protein meals require 30% additional insulin to prevent delayed postprandial hyperglycaemia.
Adolescent
Adult
Blood Glucose
/ metabolism
Child
Cross-Over Studies
Diabetes Mellitus, Type 1
/ drug therapy
Diet, High-Protein
Dietary Proteins
Dose-Response Relationship, Drug
Female
Humans
Hyperglycemia
/ metabolism
Hypoglycemic Agents
/ administration & dosage
Insulin
/ administration & dosage
Insulin Infusion Systems
Male
Meals
Time Factors
Young Adult
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
accepted:
09
04
2020
pubmed:
17
4
2020
medline:
7
9
2021
entrez:
17
4
2020
Statut:
ppublish
Résumé
To determine the amount of additional insulin required for a high-protein meal to prevent postprandial hyperglycaemia in individuals with type 1 diabetes using insulin pump therapy. In this randomized cross-over study, 26 participants aged 8-40 years, HbA The 100% dosing resulted in postprandial hyperglycaemia. From 120 min, ≥ 130% doses resulted in significantly lower postprandial glycaemic excursions compared with 100% (P < 0.05). A 130% dose produced a mean (sd) glycaemic excursion that was 4.69 (2.42) mmol/l lower than control, returning to baseline by 4 h (P < 0.001). From 120 min, there was a significant increase in the risk of hypoglycaemia compared with control for 145% [odds ratio (OR) 25.4, 95% confidence interval (CI) 5.5-206; P < 0.001) and 160% (OR 103, 95% CI 19.2-993; P < 0.001). Some 81% (n = 21) of participants experienced hypoglycaemia following a 160% dose, whereas 58% (n = 15) experienced hypoglycaemia following a 145% dose. There were no hypoglycaemic events reported with 130%. The addition of 30% more insulin to a standard dose for a high-protein meal, delivered using a combination bolus, improves postprandial glycaemia without increasing the risk of hypoglycaemia.
Substances chimiques
Blood Glucose
0
Dietary Proteins
0
Hypoglycemic Agents
0
Insulin
0
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1185-1191Subventions
Organisme : John Hunter Children's Hospital Charitable Trust
ID : 1800407
Pays : International
Informations de copyright
© 2020 Diabetes UK.
Références
Deeb A, Al Hajeri A, Alhmoudi I, Nagelkerke N. Accurate carbohydrate counting is an important determinant of postprandial glycemia in children and adolescents with type 1 diabetes on insulin pump therapy. J Diabetes Sci Technol 2017; 11: 753-758.
Hanefeld M, Temelkova-Kurktschiev T. Control of post-prandial hyperglycemia-an essential part of good diabetes treatment and prevention of cardiovascular complications. Nutr Metab Cardiovasc Dis 2002; 12: 98-107.
Smart CE, Evans M, O’Connell SM, McElduff P, Lopez PE, Jones TW 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: 3897-3902.
Paterson MA, Smart CE, Lopez PE, McElduff P, Attia J, Morbey C et al. Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy. Diabet Med 2016; 33: 592-598.
Paterson MA, Smart CEM, Lopez PE, Howley P, McElduff P, Attia J et al. Increasing the protein quantity in a meal results in dose-dependent effects on postprandial glucose levels in individuals with Type 1 diabetes mellitus. Diabet Med 2017; 34: 851-854.
Evans M, Smart CEM, Paramalingam N, Smith G, Jones TW, King BR et al. Dietary protein affects both the dose and pattern of insulin delivery required to achieve postprandial euglycaemia in Type 1 diabetes: a randomized trial. Diabet Med 2019; 36: 499-504.
Peters AL, Davidson MB. Protein and fat effects on glucose responses and insulin requirements in subjects with insulin-dependent diabetes mellitus. Am J Clin Nutr 1993; 58: 555-560.
Piechowiak K, Dzygalo 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: 861-868.
Krebs JD, Arahill J, Cresswell P, Weatherall M, Parry-Strong A. The effect of additional mealtime insulin bolus using an insulin-to-protein ratio compared to usual carbohydrate counting on postprandial glucose in those with type 1 diabetes who usually follow a carbohydrate-restricted diet: a randomized cross-over trial. Diabetes Obes Metab 2018; 20: 2486-2489.
Amerian Diabetes Assocation. Lifestyle Managment: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42(Suppl. 1): S46-S60.
Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19(Suppl 27): 136-154.
Lopez PE, Smart CE, McElduff P, Foskett DC, Price DA, Paterson MA et al. Optimizing the combination insulin bolus split for a high-fat, high-protein meal in children and adolescents using insulin pump therapy. Diabet Med 2017; 34: 1380-1384.
Pankowska E, Blazik 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.
Kordonouri O, Hartmann R, Remus K, Bläsig S, Sadeghian E, Danne T. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatri Diabetes 2012; 13: 540-544.
Lopez PE, Evans M, King BR, Jones TW, Bell K, McElduff P et al. A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with Type 1 diabetes. Diabet Med 2018; 35: 1440-1447.
Evans MS, Smart CE, Paramalingam N, Smith G, Jones TW, King BR, Davis EA. Dietary protein impacts both the dose and pattern of insulin delivery required to achieve postprandial euglycamia in Type 1 diabates in randomised trial. Diabet Med 2019; 36: 499-504.
Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM. 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: 810-816.
Bell Kirstine J, Toschi E, Steil Garry M, Wolpert Howard A. 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: 1631-1634.
Gannon Mary C, Nuttall Frank Q, Neil Brian J, Westphal Sydney A. The insulin and glucose responses to meals of glucose plus various proteins in type II diabetic subjects. Metabolism 1988; 37: 1081-1088.
Calbet Jose AL, MacLean Dave A. Plasma glucagon and insulin responses depend on the rate of appearance of amino acids after ingestion of different protein solutions in humans. J Nutr 2002; 132: 2174-2182.
Hellmig S, Von Schöning E, Gadow C, Katsoulis S, Hedderich J, Folsch UR et al. Gastric emptying time of fluids and solids in healthy subjects determined by 13C breath tests: influence of age, sex and body mass index. J Gastroenterol Hepatol 2006; 21: 1832-1838.
Okabe T, Terashima H, Sakamoto A. A comparison of gastric emptying of soluble solid meals and clear fluids matched for volume and energy content: a pilot crossover study. Anaesthesia 2017; 72: 1344-1350.
Okabe T, Terashima H, Sakamoto A. A comparison of gastric emptying of soluble solid meals and clear fluids matched for volume and energy content: a pilot crossover study. Anaesthesia 2017; 72: 1344-1350.
Luijf YM, van Bon AC, Hoekstra JB, DeVries JH. Premeal injection of rapid-acting insulin reduces postprandial glycemic excursions in type 1 Diabetes. Diabetes Care 2010; 33: 2152-2155.