Dietary protein affects both the dose and pattern of insulin delivery required to achieve postprandial euglycaemia in Type 1 diabetes: a randomized trial

Abstract

Aim To quantify the insulin requirement for a high‐protein meal compared with a low‐protein meal, controlling for carbohydrate and fat content. Methods In this crossover study, young people with Type 1 diabetes were randomized to consume a high‐ (60 g) or low‐protein meal (5 g), each containing 30 g carbohydrate and 8 g fat. A variation of the insulin clamp technique was used to determine the insulin requirements to maintain euglycaemia for the following 5 h. Results A total of 11 participants (mean ± sd age 16.5 ± 2.7 years, HbA1c 52 ± 8.7 mmol/mol [6.9 ± 0.8%], diabetes duration 6.9±5.1 years) completed the study. The mean insulin requirements for the high‐protein meal were higher than for the low‐protein meal [10.3 (CI 8.2, 12.57) vs 6.7 units (CI 4.7, 8.8); P=0.001], with inter‐individual requirements ranging from 0.9 to six times the low‐protein meal requirement. Approximately half the additional insulin [1.1 units/h (CI 0.5, 1.8; P=0.001)] was given in the first 2 h, compared with an additional 0.5 units/h (CI –0.2, 1.2; P=0.148) in the second 2 h and 0.1 units (CI –0.6, 0.8; P=0.769) in the final hour. Conclusions A high‐protein meal requires ~50% more insulin to maintain euglycaemia than a low‐protein meal that contains the same quantity of carbohydrate. The majority is required within the first 2 h. Inter‐individual differences exist in insulin requirements for dietary protein.

Use of fast‐acting insulin aspart in insulin pump therapy in clinical practice

“…As a starting point for high‐fat and high‐protein meals, 30% of the total insulin dose can be administered immediately and 70% administered with a delay over the 2–4 hours following the meal. It should also be noted that more insulin than that calculated by carbohydrate counting alone may be needed …”

Impact of dietary protein on postprandial glycaemic control and insulin requirements in Type 1 diabetes: a systematic review

“…Methods used to assess postprandial glycaemia included CGM venous blood sampling , and capillary glucose testing , with three of the included studies using a combination of both capillary testing and CGM . Studies measured postprandial glycaemia and fasted after test meals for 3 h , 4 h , 5 h , 6 h , 10 h and 12 h , respectively.…”

“…All studies included participants using intensive insulin therapy, with seven studies including participants using insulin pump or multiple daily injection (MDI) therapies , five using pump only and two using an intravenous insulin infusion during the study period . Nine of the studies described pre‐study optimization of insulin profiles by trained research personnel .…”

“…One study did not define the type of food used for the test meals. Eleven studies included carbohydrate in the test meal (keeping the amount of carbohydrate consistent) in amounts ranging from 14 to 87 g. Six studies tested the glycaemic response to protein when consumed with 3.3–56.4 g fat .…”

“…The included studies totalled 206 participants; seven studies were carried out in adults [18][19][20][21][22][23][24], four in children (8-12 years) and adolescents (13-18 years) [3,[25][26][27], and two in children, adolescents and adults (8-40 years) [4,13]. Included studies were published from 1992 to 2018.…”