For a high fat, high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with type 1 diabetes using multiple daily injections: A cross‐over trial

Abstract

Controlling postprandial glucose variability remains a challenge for people living with type 1 diabetes. In addition to carbohydrate, recent systematic reviews have identified fat and protein as modifiers of the postprandial glycaemic profile. 1,2 Dietary fat and protein have been shown to significantly increase and delay the peak glucose excursion 3,4 and

Insulin strategies for dietary fat and protein in type 1 diabetes: A systematic review

“…15,29 The remaining three studies included participants only using multiple daily injection (MDI) therapy. 21,23,28 All studies used rapid-acting meal insulin. Twelve of the included studies reported optimising participants' insulin doses prior to starting the study.…”

“…To measure postprandial glucose levels six studies used continuous glucose monitoring, 17,[25][26][27][28][29] three used venous blood testing, 5,15,18 six used capillary blood testing 13,14,[20][21][22][23] and a further three studies used a combination of continuous glucose monitoring and capillary blood testing. 16,19,24 Studies measured glucose for 3, 14,16…”

“…Eleven of the included studies evaluated fat in combination with pr otein. 5,14,15,17,19,[23][24][25][26][27][28] In these studies, the amount of protein ranged from 12 to 60 g per serve and included sources such as beef, fish, chicken, egg, salami, peanuts, whole milk, cheese, yoghurt and whey protein powder. All but one study 14 included carbohydrate in the test meals in amounts ranging from 2 to 115 g. Studies maintained consistent carbohydrate and where applicable, protein across control and intervention meals.…”

“…Of the 18 included studies, 13 studies gave additional insulin to manage postprandial glycaemia following fat and fat and protein meals. 5,[13][14][15][17][18][19]21,[23][24][25][26]28 These studies used different methods to determine insulin requirements for dietary fat and protein (Table S1).…”

Outside in

“…Two papers this month explore these challenges for people with type 1 diabetes and, importantly, explore potential strategies for people using a multiple dose injection regimen as well as for insulin pump users. 2,3 Perhaps unsurprisingly, high-fat, high-protein meals require additional insulin to minimise post-prandial glucose, but the finding that this can be safely achieved without an increase in exposure to early or late hypoglycaemia is particularly reassuring. These are small studies and, as always, inter-individual variability means that one solution will not be suitable for everyone living with type 1 diabetes, but simple, clear, practical guidance can be delivered based on the data, ensuring we continue to improve the effectiveness of peripherally delivered insulins.…”