Srinivas Laxminarayan1, Jaques Reifman1, Stephanie S Edwards2, Howard Wolpert2,3, Garry M Steil3,4. 1. 1 Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center , U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland. 2. 2 Joslin Diabetes Center , Boston, Massachusetts. 3. 3 Harvard Medical School , Boston, Massachusetts. 4. 4 Children's Hospital , Boston, Massachusetts.
Abstract
BACKGROUND: Traditionally, insulin bolus calculations for managing postprandial glucose levels in individuals with type 1 diabetes rely solely on the carbohydrate content of a meal. However, recent studies have reported that other macronutrients in a meal can alter the insulin required for good postprandial control. Specifically, studies have shown that high-fat (HF) meals require more insulin than low-fat (LF) meals with identical carbohydrate content. Our objective was to assess the mechanisms underlying the higher insulin requirement observed in one of these studies. MATERIALS AND METHODS: We used a combination of previously validated metabolic models to fit data from a study comparing HF and LF dinners with identical carbohydrate content in seven subjects with type 1 diabetes. For each subject and dinner type, we estimated the model parameters representing the time of peak meal-glucose appearance (τ(m)), insulin sensitivity (S(I)), the net hepatic glucose balance, and the glucose effect at zero insulin in four time windows (dinner, early night, late night, and breakfast) and assessed the differences in model parameters via paired Wilcoxon signed-rank tests. RESULTS: During the HF meal, the τ(m) was significantly delayed (mean and standard error [SE]: 102 [14] min vs. 71 [4] min; P = 0.02), and S(I) was significantly lower (7.25 × 10(-4) [1.29 × 10(-4)] mL/μU/min vs. 8.72 × 10(-4) [1.08 × 10(-4)] mL/μU/min; P = 0.02). CONCLUSIONS: In addition to considering the putative delay in gastric emptying associated with HF meals, we suggest that clinicians reviewing patient records consider that the fat content of these meals may alter S(I).
RCT Entities:
BACKGROUND: Traditionally, insulin bolus calculations for managing postprandial glucose levels in individuals with type 1 diabetes rely solely on the carbohydrate content of a meal. However, recent studies have reported that other macronutrients in a meal can alter the insulin required for good postprandial control. Specifically, studies have shown that high-fat (HF) meals require more insulin than low-fat (LF) meals with identical carbohydrate content. Our objective was to assess the mechanisms underlying the higher insulin requirement observed in one of these studies. MATERIALS AND METHODS: We used a combination of previously validated metabolic models to fit data from a study comparing HF and LF dinners with identical carbohydrate content in seven subjects with type 1 diabetes. For each subject and dinner type, we estimated the model parameters representing the time of peak meal-glucose appearance (τ(m)), insulin sensitivity (S(I)), the net hepatic glucose balance, and the glucose effect at zero insulin in four time windows (dinner, early night, late night, and breakfast) and assessed the differences in model parameters via paired Wilcoxon signed-rank tests. RESULTS: During the HF meal, the τ(m) was significantly delayed (mean and standard error [SE]: 102 [14] min vs. 71 [4] min; P = 0.02), and S(I) was significantly lower (7.25 × 10(-4) [1.29 × 10(-4)] mL/μU/min vs. 8.72 × 10(-4) [1.08 × 10(-4)] mL/μU/min; P = 0.02). CONCLUSIONS: In addition to considering the putative delay in gastric emptying associated with HF meals, we suggest that clinicians reviewing patient records consider that the fat content of these meals may alter S(I).
Authors: Malgorzata E Wilinska; Jan Blaha; Ludovic J Chassin; Jeremy J Cordingley; Natalie C Dormand; Martin Ellmerer; Martin Haluzik; Johannes Plank; Dirk Vlasselaers; Pieter J Wouters; Roman Hovorka Journal: Diabetes Technol Ther Date: 2011-04-13 Impact factor: 6.118
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