Kirstine J Bell1, Elena Toschi2, Garry M Steil3, Howard A Wolpert4. 1. Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, New South Wales, Australia Joslin Diabetes Center, Boston, MA. 2. Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA. 3. Harvard Medical School, Boston, MA Boston Children's Hospital, Boston, MA. 4. Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA howard.wolpert@joslin.harvard.edu.
Abstract
OBJECTIVE: To determine insulin dose adjustments required for coverage of high-fat, high-protein (HFHP) meals in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive model-predictive insulin bolus until target postprandial glycemic control was achieved. RESULTS: With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320 ± 2,960 vs. 27,092 ± 1,709 mg/dL ⋅ min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%-124%) with a 30%/70% split over 2.4 h. CONCLUSIONS: This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.
OBJECTIVE: To determine insulin dose adjustments required for coverage of high-fat, high-protein (HFHP) meals in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive model-predictive insulin bolus until target postprandial glycemic control was achieved. RESULTS: With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320 ± 2,960 vs. 27,092 ± 1,709 mg/dL ⋅ min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%-124%) with a 30%/70% split over 2.4 h. CONCLUSIONS: This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.
Authors: Stamatina Zavitsanou; Jennifer Massa; Sunil Deshpande; Jordan E Pinsker; Mei Mei Church; Camille Andre; Francis J Doyle Iii; Alicia Michelson; Jamie Creason; Eyal Dassau; David M Eisenberg Journal: Diabetes Technol Ther Date: 2019-06-21 Impact factor: 6.118
Authors: Melanie B Gillingham; Zoey Li; Roy W Beck; Peter Calhoun; Jessica Castle; Mark Clements; Eyal Dassau; Francis J Doyle; Robin L Gal; Peter Jacobs; Susana R Patton; Michael R Rickels; Michael Riddell; Corby K Martin Journal: Diabetes Technol Ther Date: 2020-09-29 Impact factor: 6.118
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