Do the Types of Dietary Carbohydrate and Protein Affect Postprandial Glycemia in Type 1 Diabetes?

Abstract

Background/Objectives: Dietary protein and carbohydrate affect postprandial glycemia in individuals with type 1 diabetes (T1D). This paper aimed to determine the relationship between the types of dietary protein (Study 1) and carbohydrate (glycemic index; GI, Study 2) and postprandial glycemia. Methods: Two acute randomized crossover trials were conducted in adults with T1D comparing postprandial glycemia for test meals varying by protein type (n = 16 adults; 5 meals: egg, beef, chicken, salmon or whey (all 30 g protein), each served with fried rice (45 g carbohydrate) or GI (n = 8 adults, high or low GI bread, GI 52% vs. 76%) with peanut butter (19 g protein, 30 g fat). Insulin was dosed based on usual individualized insulin: carbohydrate ratio and capillary blood glucose levels (BGL) measured from 30 min pre- to 5 h postprandially in 15-30 min intervals. Results: Study 1: Postprandial glycemia varied over an almost 2-fold range, however responses were highly variable and there were no significant differences between sources (iAUCglucose Chicken: 203 ± 66 mmol·min/L, Egg: 263 ± 100 mmol·min/L, Beef: 309 ± 89 mmol·min/L, Salmon: 338 ± 83 mmol·min/L and Whey: 397 ± 115 mmol·min/L respectively, p > 0.05). Hypoglycemia (≤3.5 mmol/L) occurred at least once per protein type (chicken: 6/16 participants, egg 2/16, beef 3/16, salmon 1/16, whey 2/16). However, there were no statistically significant differences in the risk of hypoglycemia between protein sources (p > 0.05). Study 2: Postprandial glucose response curves were virtually identical for high GI and low GI, and the incremental area under the curve (iAUC) for glucose was not statistically significant after 1 h (p = 0.185), 3 h (p = 0.538) or 5 h (p = 0.694) following the meal. Conclusions: Clinical practice guidelines and insulin dosing algorithms likely do not need to consider differences in protein sources or in GI in the context of a high fat, high protein meals, for individuals with T1D.

Keywords: carbohydrate; insulin dosing; postprandial glycemia; protein; type 1 diabetes.

Figure 1

Mean blood glucose levels (A) and Incremental area under the curve (iAUC) for blood glucose over 5 h (B) following 5 protein types (egg, beef, chicken, salmon and whey) with identical carbohydrate content in adults with type 1 diabetes (n = 16).

Figure 2

Mean blood glucose levels (A) and Incremental area under the curve (iAUC) for blood glucose over 3 h (B) following a high GI vs. Low GI carbohydrate source within an identical high fat, high protein mixed meal in adults with type 1 diabetes (n = 8).