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. 2017 Oct 10:10:15-21.
doi: 10.1016/j.jcte.2017.10.002. eCollection 2017 Dec.

Protein and fat meal content increase insulin requirement in children with type 1 diabetes - Role of duration of diabetes

M van der Hoogt  1 , J C van Dyk  2 , R C Dolman  1 , M Pieters  1
Affiliations

Protein and fat meal content increase insulin requirement in children with type 1 diabetes - Role of duration of diabetes

M van der Hoogt et al. J Clin Transl Endocrinol. .

Abstract

Background and objective: Hyperglycaemia remains a challenge in type 1 diabetes since current regimes used to determine meal insulin requirements prove to be ineffective. This is particularly problematic for meals containing high amounts of protein and fat. We aimed to determine the post-prandial glycaemic response and total insulin need for mixed meals, using sensor-augmented insulin pumps in children with type 1 diabetes.

Methods: Twenty-two children with type 1 diabetes, aged 4-17 years on insulin pump therapy completed this home-based, cross-over, randomised controlled trial. Two meals with identical carbohydrate content - one with low fat and protein (LFLP) and one with high fat and protein (HFHP) contents - were consumed using normal insulin boluses. Blood glucose monitoring was done for 10 h post-meal, with correction bolus insulin given two-hourly if required.

Results: The HFHP meal required significantly more total insulin (3.48 vs. 2.7 units) as a result of increased post-meal correction insulin requirement (1.2 vs. 0.15 units) spread over a longer duration (6 vs. 3 h). The HFHP meals significantly increased the time spent above target glucose level. Duration of diabetes and total daily insulin use significantly influenced the post-prandial blood glucose response to the two meals.

Conclusion: When consuming carbohydrate-based mixed meals, children with type 1 diabetes on insulin pump therapy, required significantly more insulin over a longer period of time than the insulin requirement calculated using current regimes. This additional amount required is influenced by the duration of diabetes and total daily insulin use.

Keywords: Carbohydrate; Glucose; Insulin infusion systems; Protein and fat; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
Blood glucose levels before (Time 0 h) and after (Time 0.5–10 h) intervention ■ – High fat, high protein meal; ▲ – Low fat, low protein meal; mean and 95% CI * – significant difference between the two meals (p < .05) at the respective time points.
Fig. 2
Fig. 2
Meal bolus (T 0 h) and correction insulin (T 2–10 h) ■ – High fat, high protein meal; ▲ – Low fat, low protein meal; mean and 95% CI * – significant difference between the two meals (p < .05).
See this image and copyright information in PMC

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