- Title
- Additional Insulin Is Required in Both the Early and Late Postprandial Periods for Meals High in Protein and Fat: A Randomized Trial
- Creator
- Keating, Barbara; Smart, Carmel E. M.; Harray, Amelia J.; Paramalingam, Nirubasini; Smith, Grant; Jones, Timothy W.; King, Bruce R.; Davis, Elizabeth A.
- Relation
- Journal of Clinical Endocrinology and Metabolism Vol. 106, Issue 9, p. e3611-e3618
- Publisher Link
- http://dx.doi.org/10.1210/clinem/dgab318
- Publisher
- Oxford University Press
- Resource Type
- journal article
- Date
- 2021
- Description
- Context: The pattern and quantity of insulin required for high-protein high-fat (HPHF) meals is not well understood. Objective: This study aimed to determine the amount and delivery pattern of insulin required to maintain euglycemia for 5 hours after consuming a HPHF meal compared with a low-protein low-fat (LPLF) meal. Methods: This randomized crossover clinical trial, conducted at 2 Australian pediatric diabetes centers, included 10 patients (12-21 years of age) with type 1 diabetes for ≥ 1 year. Participants were randomized to HPHF meal (60 g protein, 40 g fat) or LPLF meal (5 g protein, 5 g fat) with identical carbohydrate content (30 g). A modified insulin clamp technique was used to determine insulin requirements to maintain postprandial euglycemia for 5 hours. Total mean insulin requirements over 5 hours were measured. Results: The total mean insulin requirements for the HPHF meal were significantly greater than for the LPLF meal (11.0 [CI 9.2, 12.8] units vs 5.7 [CI 3.8, 7.5] units; P = 0.001). Extra intravenous insulin was required for HPHF: 0 to 2 hours (extra 1.2 [CI 0.6, 1.6] units/h), 2 to 4 hours (extra 1.1 [CI 0.6, 1.6] units/h), and 4 to 5 hours (extra 0.6 [CI 0.1, 1.1] units/h) after the meal. There were marked inter-individual differences in the quantity of additional insulin (0.3 to 5 times more for HPHF) and the pattern of insulin delivery (0%-85% of additional insulin required in the first 2 hours). Conclusion: The addition of protein and fat to a standardized carbohydrate meal almost doubled the mean insulin requirement, with most participants requiring half of the additional insulin in the first 2 hours.
- Subject
- insulin; type 1 diabetes; postprandial period; glycemia; fat; protein; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1473450
- Identifier
- uon:49023
- Identifier
- ISSN:0021-972X
- Rights
- x
- Language
- eng
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