The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management

Abstract

A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies.

Fig. 1

Continuous glucose sensor results demonstrating the impact of macronutrients on postprandial glycaemia. Graph A is a 10-year-old female with type 1 diabetes on insulin pump therapy who was well controlled but ate pizza at 18:00 (red line). The standard bolus did cover the first 2 h but then she developed extended hyperglycaemia. Graph B is an 18-year-old male with type 1 diabetes on insulin pump therapy who ate fried chicken at 22:00 (blue line). The standard bolus controlled the initial postprandial period but he developed hyperglycaemia 3 h later which lasted 6 h. (With permission from: Smart, C. Diabetes Care for Children and Young People. Diabetes and Primary Care 2013, 2(2):71–73) [15]