Dietary Carbohydrate, a Big Mac, and Insulin Requirements in Type I Diabetes

Fv, Vlachokosta; Cm, Piper; Gleason, Ray E.; Kinzel, Laura S.; Cr, Kahn

doi:10.2337/diacare.11.4.330

Cited by 16 publications

(14 citation statements)

References 30 publications

(32 reference statements)

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“…Similar experiments by other groups have yielded substantially similar results (15). Moreover, it has been clearly demonstrated in IDDM patients that the amount of carbohydrate in the meal influences postprandial blood glucose concentrations, even if the amount of insulin injected is modified according to the carbohydrate content of the meal (32,33).…”

Section: Fig 2 Mean ± Se Daily Blood Glucose Profiles Recorded 15 Dmentioning

confidence: 63%

Effects of Dietary Fiber and Carbohydrate on Glucose and Lipoprotein Metabolism in Diabetic Patients

Riccardi

Rivellese²

1991

Diabetes Care

163

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Dietary recommendations for the treatment of diabetic patients issued by national and international diabetes associations consistently emphasize the need to increase carbohydrate consumption. However, these recommendations have been questioned on the basis of growing evidence that, in both insulin-dependent and non-insulin-dependent diabetic patients, a high-carbohydrate diet does not offer any advantage in terms of blood glucose and plasma lipid concentrations compared with a high-fat (mainly unsaturated) diet. It has been shown repeatedly that a high-carbohydrate diet increases plasma insulin and triglyceride levels and can deteriorate blood glucose control in the postprandial period. However, much of the controversy between advocates and detractors of dietary carbohydrate can be settled by taking into account dietary fiber. Several studies have shown that the adverse metabolic effects of high-carbohydrate diets are neutralized when fiber and carbohydrate are increased simultaneously in the diet for diabetic patients. In particular, these studies demonstrated that a high-carbohydrate/high-fiber diet significantly improves blood glucose control and reduces plasma cholesterol levels in diabetic patients compared with a low-carbohydrate/low-fiber diet. In addition, a high-carbohydrate/high-fiber diet does not increase plasma insulin and triglyceride concentrations, despite the higher consumption of carbohydrates. Unfortunately, dietary fiber represents a heterogenous category, and there is still much to understand as to which foods should be preferred to maximize the metabolic effects of fiber. There are indications that only water-soluble fiber is active on plasma glucose and lipoprotein metabolism in humans. Therefore, in practice, the consumption of legumes, vegetables, and fruits--rich in water-soluble fiber--should be particularly encouraged. The mechanisms by which dietary fiber exerts its hypoglycemic and hypolipidemic activities are unknown. However, the ability of dietary fiber to retard food digestion and nutrient absorption certainly has an important influence on lipid and carbohydrate metabolism. The beneficial effects of high-fiber foods are also exerted by some foods not particularly rich in fiber. The fiber content and physical form of the food can influence the accessibility of nutrients by digestive enzymes, thus delaying digestion and absorption. The identification of these foods with a low-glycemic response would help enlarge the list of foods particularly suitable for diabetic patients. In conclusion, a diet low in cholesterol and saturated fat should be recommended to all diabetic patients to prevent cardiovascular disease. A balanced increase in consumption of fiber-rich foods and unsaturated fat is the most rational way to replace foods rich in saturated fat and cholesterol in the diabetic diet.

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Section: Fig 2 Mean ± Se Daily Blood Glucose Profiles Recorded 15 Dmentioning

confidence: 63%

Effects of Dietary Fiber and Carbohydrate on Glucose and Lipoprotein Metabolism in Diabetic Patients

Riccardi

Rivellese²

1991

Diabetes Care

163

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“…Older studies examined the dietary effects on insulin needs using an “artificial pancreas”, termed a Biostator, to regulate glycemia by infusing i.v. insulin based on continuous glucose sensing 7,8 . These studies showed that meal macronutrient composition and the time of feeding affect insulin needs.…”

Section: Discussionmentioning

confidence: 99%

Antecedent caloric intake and glucose excursion following a subsequent meal in Type 1 diabetes

Mehra

Raman

Bayless

et al. 2009

Journal of Diabetes

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Background: In the present study, we tested the hypothesis that calories consumed at a prior meal (lunch) may impair glycemic control after a subsequent meal (supper) even if the pre‐supper glucose did not differ regardless of the size of the lunch meal. Methods: Nine subjects with Type 1 diabetes using continuous subcutaneous (s.c.) insulin infusion (CSII) therapy were studied on two separate days. Lunch (1200 h) was randomly assigned as 25% or 50% of the usual daily intake on alternate study days. The CSII was stopped at 1000 h on the day of the study and glucose was controlled until supper by adjusting the rate of intravenous (i.v.) insulin based on glucose measurements every 15 min. The CSII was restarted 1 h before supper and i.v. insulin discontinued 15 min before the first bite of supper. An identical supper meal and pre‐supper s.c. bolus of short‐acting insulin were administered on both visits. Results: Pre‐supper glycemia was nearly identical on each of the two study days. However, the post‐supper glucose area under the curve was 27.5% greater on the day of the antecedent large lunch compared with the small lunch (P = 0.0039). Conclusions: For optimal postprandial glucose control, people with Type 1 diabetes may need to consider not only anticipated meal calories, but also prior food intake, a practice not commonly recommended based on currently used insulin dosing algorithms.

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“…Figure 1. The sensitivity variation curve was defined by fixing main values obtained from the literature [5][6][7]9,17,21,22 and interpolating them through a piecewise cubic Hermite interpolating polynomial. The penalty curve was obtained by applying an anticipation D to the curve to take into account insulin absorption delays.…”

Section: Methodsmentioning

confidence: 99%

Dynamic Insulin on Board: Incorporation of Circadian Insulin Sensitivity Variation

Toffanin

Zisser

Doyle

et al. 2013

J Diabetes Sci Technol

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Abbreviations: (BB) basal-bolus, (BG) blood glucose, (BW) body weight, (CL) closed loop, (CR) carbohydrate ratio, (CSII) continuous subcutaneous insulin infusion, (CVGA) control-variability grid analysis, (dIOB) dynamic insulin on board, (IOB) insulin on board, (MPC) model predictive control, (sIOB) static insulin on board, (T1DM) type 1 diabetes mellitus Keywords: artificial pancreas, circadian rhythm, continuous subcutaneous insulin infusion, diabetes, insulin on board, insulin sensitivity

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Dietary Carbohydrate, a Big Mac, and Insulin Requirements in Type I Diabetes

Cited by 16 publications

References 30 publications

Effects of Dietary Fiber and Carbohydrate on Glucose and Lipoprotein Metabolism in Diabetic Patients

Effects of Dietary Fiber and Carbohydrate on Glucose and Lipoprotein Metabolism in Diabetic Patients

Antecedent caloric intake and glucose excursion following a subsequent meal in Type 1 diabetes

Dynamic Insulin on Board: Incorporation of Circadian Insulin Sensitivity Variation

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