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High-fat, high-protein meal requires high insulin dose
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Meal composition along with carbohydrate count should be considered when calculating insulin dosages and may provide a foundation for new insulin-dosing algorithms for meals of varying macronutrient composition, according to study results.
Howard A. Wolpert, MD, director of the insulin pump and continuous glucose monitoring programs at Joslin Diabetes Center and associate professor of medicine at Harvard University, and colleagues evaluated 10 adults with type 1 diabetes (nine men; mean age, 60.4 years; BMI, 25.8 kg/m2; HbA1c, 7.1%; total insulin dose, 35.5 U/day). Researchers evaluated the insulin dose adjustments required for coverage of high-fat, high-protein meals.
Participants consumed low-fat, low-protein and high-fat, high-protein meals in random order during two study visits. The high-fat, high-protein meal was repeated during subsequent visits with an insulin dose estimated by a model predictive bolus algorithm.
The meals were a pizza base with marinara sauce (low-fat, low-protein) or the same pizza base with cheese (high-fat, high-protein) and had the same carbohydrate content (50 g) but differed in calories, fat and protein content. The low-fat meal had 273 calories, 4 g fat and 9 g protein, whereas the high-fat meal had 764 calories, 44 g fat and 36 g protein.
Similar fasting blood glucose concentrations were found on the two study days. The high-fat meal had more than double glucose incremental area under the curve (iAUC; 27,092 mg/dL min) compared with the low-fat meal (13,320 mg/dL min) despite using the same insulin dose (P = .0013); significant differences existed from 180 minutes onward and more than 100 mg/dL differences in glucose concentrations at 6 hours.
Sixty-five percent more insulin was required with a 30%/70% split during 2.4 hours to achieve target glucose control after the high-fat meal.
“This study demonstrates that to optimize postprandial glucose control some mealtime insulin doses may need to be based on the meal composition rather than carbohydrate content only and provides the foundation for the development of new insulin-dosing algorithms to cover [high-fat, high-protein] meals,” the researchers wrote. – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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