Additional insulin dosing for fat and protein in children with type 1 diabetes using multiple daily injections.
medical therapy
nutrition
pediatric
type 1 diabetes
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
18
02
2022
received:
20
12
2021
accepted:
24
05
2022
pubmed:
2
6
2022
medline:
10
8
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
High-fat high-protein (HFHP) meals are associated with post-prandial hyperglycemia in type 1 diabetes (T1D), administration of additional insulin for such meals is recommended in order to optimize glucose levels. Optimal timing of additional insulin for HFHP meals in children and young people receiving multiple daily injections (MDI) remains unclear. To investigate the glycemic impact of additional insulin doses given before or after eating a HFHP meal in children with T1D using MDI. A randomized, controlled three period crossover trial of 27 participants aged 13 years (6.1-17.7) at two Pediatric Diabetes centers was conducted. Additional rapid-acting insulin for the fat-protein content of a standardized HFHP meal was given at three time points There was no difference in post-prandial glucose parameters when additional HFHP insulin was administered at We found no benefit in giving additional insulin as a split dose for HFHP meals in children using MDI, mild hypoglycemia was common. Future studies would benefit from refinement of the insulin dose algorithm.
Substances chimiques
Blood Glucose
0
Hypoglycemic Agents
0
Insulin
0
Banques de données
EudraCT
['2015-003666-85']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
742-748Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
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(S27):136-154.
The Diabetes Control and Complications Trial Research Group. Effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
Smart CE, Ross K, Edge JA, King BR, McElduff P, Collins CE. Can children with type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks? Diabet Med. 2010;27(3):348-353.
Smart CE, Ross K, Edge JA, Collins CE, Colyvas K, King BR. Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting. Diabet Med. 2009;26:279-285.
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. Pediatr Diabetes. 2012;13(7):540-544.
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(12):3897-3902.
Pańkowska E, Szypowska A, Lipka M, Szpotańska M, Błazik M, Groele L. 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(5):298-303.
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(1):16-22.
Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpart HA. Impact of fat, protein and Glycaemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the CGM era. Diabetes Care. 2015;38:1008-1015.
Lopez PE, Evans M, King BR, et al. A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with type 1 diabetes. Diabet Med. 2018;00:1-8.
Smith TA, Smart CE, Howley PP, Lopez P, King BR. For a high fat, high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with type 1 diabetes using multiple daily injections: a cross-over trial. Diabet Med. 2021;38(7):e14512. doi:10.1111/dme.14512
Smith T, Marlow A, King B, Smart C. Insulin strategies for dietary fat and protein in type 1 diabetes: a systematic review. Diabet Med. 2021;38:e14641.
Smart CE, King BR, Lopez PE. Insulin dosing for fat and protein: is it time? Diabetes Care. 2020;43:13-15.
Bell KJ, Fio CZ, Twigg S, et al. Amount and type of dietary fat, postprandial glycemia, and insulin requirements in type 1 diabetes: a randomized within-subject trial. Diabetes Care. 2020;43:59-66.
Evans M, Smart CEM, Paramalingam N, 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(4):499-504. doi:10.1111/dme.13875
Smith TA, Smart CE, Fuery MA, et al. N children and young people with type 1 diabetes using pump therapy, an additional 40% of the insulin dose for a high-fat, high-protein breakfast improves postprandial glycaemic excursions: a cross-over trial. Diabet Med. 2021;38:e14511.