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Randomized Controlled Trial
. 2022 Sep;23(6):742-748.
doi: 10.1111/pedi.13372. Epub 2022 Jun 14.

Additional insulin dosing for fat and protein in children with type 1 diabetes using multiple daily injections

Anne Marie Frohock  1 , Jason Oke  2 , Chandan Yaliwal  3 , Julie Edge  4 , Rachel E J Besser  4   5
Affiliations
Randomized Controlled Trial

Additional insulin dosing for fat and protein in children with type 1 diabetes using multiple daily injections

Anne Marie Frohock et al. Pediatr Diabetes. 2022 Sep.

Abstract

Objective: 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.

Aim: To investigate the glycemic impact of additional insulin doses given before or after eating a HFHP meal in children with T1D using MDI.

Research design and methods: 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 + 0 + 1 + 2 h of usual pre - prandial carbohydrate insulin ; calculated using an algorithm extrapolated from current evidence base and clinical recommendations. Post-prandial glucose (PPG) parameters were calculated for 420 minutes using continuous glucose monitoring. The primary outcome was mean PPG excursion. Secondary outcomes included peak glucose, time to peak and hypoglycemia incidence.

Results: There was no difference in post-prandial glucose parameters when additional HFHP insulin was administered at + 0 , + 1 , or + 2 h : mean glucose excursion (mmol/L) (SE): 1.9(0.7), 1.2(0.7), 2.5(0.7); p = 0.5); mean peak glucose (mmol/L)(SE): 10.9(0.9), 11.5(0.8), 11.5(0.9); p = 0.9; time to peak glucose (mins)(SE): 82.3(35.4), 113.6(30.9), 95.1(32.1); p = 0.8. Mild hypoglycemia was common (55%) in all groups (p = 0.97).

Conclusion: 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.

Keywords: medical therapy; nutrition; pediatric; type 1 diabetes.

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References

REFERENCES

    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.

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