P E Lopez1,2,3,4, C E Smart1,2,4, P McElduff2,3, D C Foskett5, D A Price6,7,8, M A Paterson1,2,3,4, B R King1,2,3,4. 1. John Hunter Hospital, Newcastle, NSW, Australia. 2. University of Newcastle, Newcastle, NSW, Australia. 3. Hunter Medical Research Institute, Newcastle, NSW, Australia. 4. Mothers and Babies Research Centre, Newcastle, NSW, Australia. 5. Insulin Pump Angels, Gold Coast, Queensland, Australia. 6. Pacific Private Clinic, Gold Coast, Queensland, Australia. 7. Bond University, Gold Coast, Queensland, Australia. 8. Griffith University, Gold Coast, Queensland, Australia.
Abstract
AIMS: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. METHODS: A total of 19 young people (mean age 12.9 ± 6.7 years) participated in a randomized, repeated-measures trial comparing postprandial glycaemic control across six study conditions after a high-fat and high-protein meal. A standard bolus and five different combination boluses were delivered over 2 h in the following splits: 70/30 = 70% standard /30% extended bolus; 60/40=60% standard/40% extended bolus; 50/50=50% standard/50% extended bolus; 40/60=40% standard/60% extended bolus; and 30/70=30% standard/70% extended bolus. Insulin dose was determined using the participant's optimized insulin:carbohydrate ratio. Continuous glucose monitoring was used to assess glucose excursions for 6 h after the test meal. RESULTS: Standard bolus and combination boluses 70/30 and 60/40 controlled the glucose excursion up to 120 min. From 240 to 300 min after the meal, the glucose area under the curve was significantly lower for combination bolus 30/70 compared with standard bolus (P=0.004). CONCLUSIONS: High-fat and high-protein meals require a ≥60% insulin:carbohydrate ratio as a standard bolus to control the initial postprandial rise. Additional insulin at an insulin:carbohydrate ratio of up to 70% is needed in the extended bolus for a high fat and protein meal to prevent delayed hyperglycaemia.
RCT Entities:
AIMS: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. METHODS: A total of 19 young people (mean age 12.9 ± 6.7 years) participated in a randomized, repeated-measures trial comparing postprandial glycaemic control across six study conditions after a high-fat and high-protein meal. A standard bolus and five different combination boluses were delivered over 2 h in the following splits: 70/30 = 70% standard /30% extended bolus; 60/40=60% standard/40% extended bolus; 50/50=50% standard/50% extended bolus; 40/60=40% standard/60% extended bolus; and 30/70=30% standard/70% extended bolus. Insulin dose was determined using the participant's optimized insulin:carbohydrate ratio. Continuous glucose monitoring was used to assess glucose excursions for 6 h after the test meal. RESULTS: Standard bolus and combination boluses 70/30 and 60/40 controlled the glucose excursion up to 120 min. From 240 to 300 min after the meal, the glucose area under the curve was significantly lower for combination bolus 30/70 compared with standard bolus (P=0.004). CONCLUSIONS: High-fat and high-protein meals require a ≥60% insulin:carbohydrate ratio as a standard bolus to control the initial postprandial rise. Additional insulin at an insulin:carbohydrate ratio of up to 70% is needed in the extended bolus for a high fat and protein meal to prevent delayed hyperglycaemia.
Authors: Mark Evans; Antonio Ceriello; Thomas Danne; Christophe De Block; J Hans DeVries; Marcus Lind; Chantal Mathieu; Kirsten Nørgaard; Eric Renard; Emma G Wilmot Journal: Diabetes Obes Metab Date: 2019-06-19 Impact factor: 6.577
Authors: Alison B Evert; Michelle Dennison; Christopher D Gardner; W Timothy Garvey; Ka Hei Karen Lau; Janice MacLeod; Joanna Mitri; Raquel F Pereira; Kelly Rawlings; Shamera Robinson; Laura Saslow; Sacha Uelmen; Patricia B Urbanski; William S Yancy Journal: Diabetes Care Date: 2019-04-18 Impact factor: 19.112