Carbohydrate Counting at Meal Time Followed by a Small Secondary Postprandial Bolus Injection at 3 Hours Prevents Late Hyperglycemia, Without Hypoglycemia, After a High-Carbohydrate, High-Fat Meal in Type 1 Diabetes

Campbell, Matthew D.; Walker, Mark; King, David G.; Gonzalez, Javier T.; Allerton, Dean M.; Stevenson, Emma; Shaw, James; West, Daniel J.

doi:10.2337/dc16-0709

Cited by 29 publications

(47 citation statements)

References 5 publications

(2 reference statements)

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“…Results from recent high-fat and/or high-protein mixed meal studies continue to support previous findings that glucose response to mixed meals high in protein and/or fat along with carbohydrate differ among individuals; therefore, a cautious approach to increasing insulin doses for high-fat and/or high-protein mixed meals is recommended to address delayed hyperglycemia that may occur 3 h or more after eating (277)(278)(279)(280)(281)(282)(283)(284)(285)(286)(287)(288)(289)(290). If using an insulin pump, a split bolus feature (part of the bolus delivered immediately, the remainder over a programmed duration of time) may provide better insulin coverage for high-fat and/or high-protein mixed meals (278,281).…”

Section: Mnt and Antihyperglycemic Medications (Including Insulin)mentioning

confidence: 52%

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report

Dennison²,

et al. 2019

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This Consensus Report is intended to provide clinical professionals with evidencebased guidance about individualizing nutrition therapy for adults with diabetes or prediabetes. Strong evidence supports the efficacy and cost-effectiveness of nutrition therapy as a component of quality diabetes care, including its integration into the medical management of diabetes; therefore, it is important that all members of the health care team know and champion the benefits of nutrition therapy and key nutrition messages. Nutrition counseling that works toward improving or maintaining glycemic targets, achieving weight management goals, and improving cardiovascular risk factors (e.g., blood pressure, lipids, etc.) within individualized treatment goals is recommended for all adults with diabetes and prediabetes. Though it might simplify messaging, a "one-size-fits-all" eating plan is not evident for the prevention or management of diabetes, and it is an unrealistic expectation given the broad spectrum of people affected by diabetes and prediabetes, their cultural backgrounds, personal preferences, co-occurring conditions (often referred to as comorbidities), and socioeconomic settings in which they live. Research provides clarity on many food choices and eating patterns that can help people achieve health goals and quality of life. The American Diabetes Association (ADA) emphasizes that medical nutrition therapy (MNT) is fundamental in the overall diabetes management plan, and the need for MNT should be reassessed frequently by health care providers in collaboration with people with diabetes across the life span, with special attention during times of changing health status and life stages (1-3). This Consensus Report now includes information on prediabetes, and previous ADA nutrition position statements, the last of which was published in 2014 (4), did not. Unless otherwise noted, the research reviewed was limited to those studies conducted in adults diagnosed with prediabetes, type 1 diabetes, and/or type 2 diabetes. Nutrition therapy for children with diabetes or women with gestational diabetes mellitus is not addressed in this review but is covered in other ADA publications, specifically Standards of Medical Care in Diabetes (5,6).

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Section: Mnt and Antihyperglycemic Medications (Including Insulin)mentioning

confidence: 52%

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report

Dennison²,

et al. 2019

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“…Split insulin doses have also been recommended by some centers, however, there is only one published study that has investigated this. 124 This study found that for a high fat, highcarbohydrate meal administration of 130% of the prandial insulin dose as a split bolus (100%: 30%), 3 hours postmeal consumption produced a glycemic response similar to the low-fat (5 g) control condition with no increase in hypoglycemic episodes. When this dose was delivered as a normal bolus, however, the incidence of hypoglycemia significantly increased.…”

Section: Timing and Type Of Insulin Bolusesmentioning

confidence: 71%

“…For those on MDI, clinical experience at some centers suggests short‐acting (regular/soluble) insulin may be given when a prolonged insulin effect is desired to match certain meals, for example high fat, carbohydrate dense foods. Split insulin doses have also been recommended by some centers, however, there is only one published study that has investigated this . This study found that for a high fat, high‐carbohydrate meal administration of 130% of the prandial insulin dose as a split bolus (100%: 30%), 3 hours postmeal consumption produced a glycemic response similar to the low‐fat (5 g) control condition with no increase in hypoglycemic episodes.…”

Section: Introductionmentioning

confidence: 92%

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

et al. 2018

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“…However, even if carbohydrate counting is still the basis for insulin dose adjustment in diabetes care management, 29 data show 25 that sugar content could be a stronger predictor of the observed glucose response compared to carbohydrate. Other studies show that the structure of carbohydrates should also be keep in consideration: a disrupted structure, typical of processed whole grains, has a different effect on glycemia compared to intact grains.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Different High-Protein Low-Carbohydrates Proprietary Foods on Blood Sugar in Healthy Subjects

Lodi

Karsten

Bosco

et al. 2016

Journal of Medicinal Food

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The aim of our work was to analyze the effects on blood sugar through the calculation of the glycemic score (GS) of 10 different high-protein-low-carbohydrates proprietary foods which are commonly used as meals during very low carbohydrate ketogenic diet or during low carbohydrate diet. 14 healthy female tested the glycemic response curve elicited by 1000 Kj of glucose three times within 3 weeks period (1 test each week) compared to each of the 10 test-foods once on separate days twice a week. After determining the GS of each food in each individual, the mean GS of each test food was calculated. All test foods, compared to glucose, produced a significantly lower glycemic response . The GS of all test foods resulted lower than 25 and the difference between the mean glycemia after the intake of glucose (mean 122 ±15 mg/dl) and after the intake of the sweet test foods (mean 89 ± 7 mg/dl) was of 33 mg/dl (P<0.001), whereas that after the intake of glucose and the savory test foods (mean 91 ± 8 mg/dl ) was of 31mg/dl (P<0.001). We can conclude that the reformulation of ultra-processed ready-to-consume foods in a low carbohydrate, high protein version can produce a significant low glycemic response while maintaining the valued ready-to-use format and high palatability demanded by consumers. The low impact on postprandial glycemia and the nutritional characteristics of these proprietary foods make them useful both in weight control and in diabetes care dietary management.

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Carbohydrate Counting at Meal Time Followed by a Small Secondary Postprandial Bolus Injection at 3 Hours Prevents Late Hyperglycemia, Without Hypoglycemia, After a High-Carbohydrate, High-Fat Meal in Type 1 Diabetes

Cited by 29 publications

References 5 publications

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

The Effects of Different High-Protein Low-Carbohydrates Proprietary Foods on Blood Sugar in Healthy Subjects

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