Additional Insulin Is Required in Both the Early and Late Postprandial Periods for Meals High in Protein and Fat: A Randomized Trial
| Autor: | Timothy W. Jones, Carmel E. Smart, Amelia J. Harray, Nirubasini Paramalingam, Bruce R. King, Grant J. Smith, Barbara Keating, Elizabeth A. Davis |
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| Rok vydání: | 2021 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Low protein Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Biochemistry 030209 endocrinology & metabolism Context (language use) Biochemistry law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Endocrinology Randomized controlled trial law Internal medicine Dietary Carbohydrates medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Child Meals Type 1 diabetes Meal Cross-Over Studies business.industry Biochemistry (medical) Carbohydrate Postprandial Period medicine.disease Dietary Fats Diabetes Mellitus Type 1 Postprandial Glucose Clamp Technique Female Dietary Proteins business |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 106:e3611-e3618 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgab318 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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