Protein and fat meal content increase insulin requirement in children with type 1 diabetes – Role of duration of diabetes

Hoogt, Maryke Van der; Dyk, J C van; Dolman, Robin; Pieters, Marlien

doi:10.1016/j.jcte.2017.10.002

Cited by 21 publications

(72 citation statements)

References 17 publications

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“…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.…”

Section: Study Demographicsmentioning

confidence: 99%

“…Methods used to assess postprandial glycaemia included CGM [3,4,13,18,20,[23][24][25]27,28] venous blood sampling [26], and capillary glucose testing [19,21,22], with three of the included studies using a combination of both capillary testing and CGM [20,25,27]…”

Section: Glucose Measurementmentioning

confidence: 99%

“…All studies included participants using intensive insulin therapy, with seven studies including participants using insulin pump or multiple daily injection (MDI) therapies [3,4,13,[20][21][22]28], five using pump only [18,[23][24][25]27] and two using an intravenous insulin infusion during the study period [19,26]. Nine of the studies described pre-study optimization of insulin profiles by trained research personnel [3,4,13,18,23,[25][26][27]. Nine studies administered insulin for the carbohydrate portion of the test meals [3,4,20,21,[23][24][25]27,28].…”

Section: Insulin Dosing Strategymentioning

confidence: 99%

“…Nine of the studies described pre-study optimization of insulin profiles by trained research personnel [3,4,13,18,23,[25][26][27]. Nine studies administered insulin for the carbohydrate portion of the test meals [3,4,20,21,[23][24][25]27,28]. Two studies gave additional insulin for the protein content of the test meals [21,25], and two studies investigated insulin dosing for protein and fat [23,27].…”

Section: Insulin Dosing Strategymentioning

confidence: 99%

“…Nine studies administered insulin for the carbohydrate portion of the test meals [3,4,20,21,[23][24][25]27,28]. Two studies gave additional insulin for the protein content of the test meals [21,25], and two studies investigated insulin dosing for protein and fat [23,27]. Two studies measured intravenous insulin requirements for the protein content of the test meals [19,26], whereas one study [26] observed the pattern of delivery, in addition to insulin requirements.…”

Section: Insulin Dosing Strategymentioning

confidence: 99%

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

et al. 2019

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Aim Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribute to postprandial glycaemic excursions with recommendations to consider protein when calculating mealtime insulin doses. The aim of this review is to identify and synthesize evidence about the glycaemic impact of dietary protein and insulin requirements for individuals with Type 1 diabetes. Methods A systematic literature search of relevant biomedical databases was performed to identify research on the glycaemic impact of dietary protein when consumed alone, and in combination with other macronutrients in individuals with Type 1 diabetes. Results The review included 14 published studies dated from 1992 to 2018, and included studies that researched the impact of protein alone (n = 2) and protein in a mixed meal (n = 12). When protein was consumed alone a glycaemic effect was not seen until ≥ 75 g. In a carbohydrate‐containing meal ≥ 12.5 g of protein impacted the postprandial glucose. Inclusion of fat in a high‐protein meal enhanced the glycaemic response and further increased insulin requirements. The timing of the glycaemic effect from dietary protein ranged from 90 to 240 min. Studies indicate that the postprandial glycaemic response and insulin requirements for protein are different when protein is consumed alone or with carbohydrate and/or fat. Conclusions This systematic review provides evidence that dietary protein contributes to postprandial glycaemic excursions and insulin requirements. These insights have important implications for the education of people with Type 1 diabetes and highlights the need for more effective insulin dosing strategies for mixed macronutrient meals.

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