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Insulin requirements higher after high-protein meals in type 1 diabetes
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It takes more insulin for adolescents with type 1 diabetes to reach euglycemia following a high-protein meal compared with a low-protein meal, according to findings published in Diabetic Medicine.
“Current guidelines for individuals with type 1 diabetes on intensive insulin therapy focus exclusively on the carbohydrate content of a meal when determining pre-meal insulin dose,” Carmel Smart, PhD, senior diabetes and endocrine dietitian at John Hunter Children’s Hospital in Newcastle, Australia, and colleagues wrote. “Carbohydrate-counting provides flexibility in dietary intake and has been shown to improve glycemic control; however, increasingly, there is evidence to suggest that protein and fat should also be considered in the calculation of the pre-meal insulin dose.”
Smart and colleagues performed a randomized crossover trial with 11 adolescents (mean age, 16.5 years; 54% girls) who were recruited from the Princess Margaret Hospital in Perth, Australia, or the John Hunter Children’s Hospital in Newcastle, Australia. Participants were required to have a type 1 diabetes diagnosis of more than 1 year and to have undertaken insulin infusion or daily injection for at least 6 months.
Two clinical visits were completed by each participant. Visits were separated by 1 week, and each visit included a test meal high in protein or low in protein. After being randomly assigned to one of these meals, each participant consumed the other meal on their next visit. The high-protein meal included 60 g protein, and the low-protein meal had 5 g. Both meals had 30 g carbohydrates and 8 g fat. During the visits, a cannula was inserted into both arms of each participant to provide blood samples and insulin delivery for 5 hours after each meal.
Blood glucose levels were higher in the 5 hours after the high-protein meal (5.95 mmol/L) compared with the 5 hours after the low-protein meal (5.68 mmol/L), which yielded a difference of 0.26 mmol/mol (95% CI, 0.11-0.42). Similarly, after eating a high-protein meal, participants needed 10.4 U insulin (95% CI, 8.2-12.5) to keep blood glucose levels within euglycemic range (5.5 mmol/L) compared with 6.7 U (95% CI, 4.7-8.8) after the low-protein meal. The researchers wrote that this 3.6-U difference meant that adolescents with type 1 diabetes needed 54% more insulin after a high-protein meal than after a low-protein one.
The association between high protein and insulin requirement was particularly strong 2 hours after eating. At 120 minutes, there was a higher marginal mean units per hour difference (1.1; 95% CI, 0.5-1.8) between the high-protein and low-protein meals compared with the second 120 minutes (0.5; 95% CI, –0.2 to 1.2) and the end of the 5 hours (0.1; 95% CI, –0.6 to 0.8).
“This study builds on previous research, directing future translation studies to determine an appropriate means to calculate and deliver the quantity of additional insulin required for the protein component of meals,” the researchers wrote. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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