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In children and young people with type 1 diabetes using Pump therapy, an additional 40% of the insulin dose for a high‐fat, high‐protein breakfast improves postprandial glycaemic excursions: A cross‐over trial
Author(s) -
Smith Tenele A.,
Smart Carmel E.,
Fuery Michelle E. J.,
Howley Peter P.,
Knight Brigid A.,
Harris Mark,
King Bruce R.
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14511
Subject(s) - medicine , postprandial , insulin , endocrinology , type 2 diabetes , type 1 diabetes , meal , diabetes mellitus , bolus (digestion) , carbohydrate
Aim To determine the insulin requirement for a high‐fat, high‐protein breakfast to optimise postprandial glycaemic excursions in children and young people with type 1 diabetes using insulin pumps. Methods In all, 27 participants aged 10–23 years, BMI <95 th percentile (2–18 years) or BMI <30 kg/m 2 (19–25 years) and HbA 1c ≤64 mmol/mol (≤8.0%) consumed a high‐fat, high‐protein breakfast (carbohydrate: 30 g, fat: 40 g and protein: 50 g) for 4 days. In this cross‐over trial, insulin was administered, based on the insulin‐to‐carbohydrate ratio (ICR) of 100% (control), 120%, 140% and 160%, in an order defined by a randomisation sequence and delivered in a combination bolus, 60% ¼ hr pre‐meal and 40% over 3 hr. Postprandial sensor glucose was assessed for 6 hr. Results Comparing 100% ICR, 140% ICR and 160% ICR resulted in significantly lower 6‐hr areas under the glucose curves: mean (95%CI) (822 mmol/L.min [605,1039] and 567 [350,784] vs 1249 [1042,1457], p ≤ 0.001) and peak glucose excursions (4.0 mmol/L [3.0,4.9] and 2.7 [1.7,3.6] vs 6.0 [5.0,6.9], p < 0.001). Rates of hypoglycaemia for 100%‐160% ICR were 7.7%, 7.7%, 12% and 19% respectively ( p ≥ 0.139). With increasing insulin dose, a step‐wise reduction in mean glucose excursion was observed from 1 to 6 hr ( p = 0.008). Conclusions Incrementally increasing the insulin dose for a high‐fat, high‐protein breakfast resulted in a predictable, dose‐dependent reduction in postprandial glycaemia: 140% ICR improved postprandial glycaemic excursions without a statistically significant increase in hypoglycaemia. These findings support a safe, practical method for insulin adjustment for high‐fat, high‐protein meals that can be readily implemented in practice to improve postprandial glycaemia.