Protein and fat meal content increase insulin requirement in children with type 1 diabetes – Role of duration of diabetes
Open accessAbstract
BACKGROUND AND OBJECTIVE: Hyperglycaemia remains a challenge in type 1 diabetes since current regimes used to determine meal insulin requirements prove to be ineffective. This is particularly problematic for meals containing high amounts of protein and fat. We aimed to determine the post-prandial glycaemic response and total insulin need for mixed meals, using sensor-augmented insulin pumps in children with type 1 diabetes. METHODS: Twenty-two children with type 1 diabetes, aged 4-17 years on insulin pump therapy completed this home-based, cross-over, randomised controlled trial. Two meals with identical carbohydrate content - one with low fat and protein (LFLP) and one with high fat and protein (HFHP) contents - were consumed using normal insulin boluses. Blood glucose monitoring was done for 10 h post-meal, with correction bolus insulin given two-hourly if required. RESULTS: 3 h). The HFHP meals significantly increased the time spent above target glucose level. Duration of diabetes and total daily insulin use significantly influenced the post-prandial blood glucose response to the two meals. CONCLUSION: When consuming carbohydrate-based mixed meals, children with type 1 diabetes on insulin pump therapy, required significantly more insulin over a longer period of time than the insulin requirement calculated using current regimes. This additional amount required is influenced by the duration of diabetes and total daily insulin use.
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If using an insulin pump, a split bolus feature may provide better insulin coverage for high-fat and/or high-protein mixed meals.
“If using an insulin pump, a split bolus feature (part of the bolus delivered immediately, the remainder over a programmed duration of time) may provide better insulin coverage for high-fat and/or high-protein mixed meals (278,281).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [281]
The Introduction says an immediate standard bolus can be ineffective for mixed meals, and the Discussion suggests extended insulin delivery may be needed for high-fat, high-protein meals. The paper does not test the specific split-bolus approach described in the claim, or establish its benefit for meals high in fat or protein alone. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDelayed hyperglycemia may occur 3 h or more after eating high-fat and/or high-protein mixed meals.
“a cautious approach to increasing insulin doses for high-fat and/or high-protein mixed meals is recommended to address delayed hyperglycemia that may occur 3 h or more after eating (277 -290).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [282]
Delayed hyperglycemia may occur 3 h or more after eating high-fat and/or high-protein mixed meals.
“a cautious approach to increasing insulin doses for high-fat and/or high-protein mixed meals is recommended to address delayed hyperglycemia that may occur 3 h or more after eating (277 -290).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [281]
Glucose response to mixed meals high in protein and/or fat along with carbohydrate differ among individuals.
“Results from recent high-fat and/or high-protein mixed meal studies continue to support previous fi ndings that glucose response to mixed meals high in protein and/or fat along with carbohydrate differ among individuals”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [282]
Glucose response to mixed meals high in protein and/or fat along with carbohydrate differ among individuals.
“Results from recent high-fat and/or high-protein mixed meal studies continue to support previous fi ndings that glucose response to mixed meals high in protein and/or fat along with carbohydrate differ among individuals”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [281]
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- Authors
- van der Hoogt, M., van Dyk, J. C., Dolman, R. C., & Pieters, M.
- Affiliations
- North-West University (ZA)
- Corresponding author
- Pieters, M.
- Venue
- Journal of Clinical & Translational Endocrinology
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 10
- Pages
- 15-21
- ISSN
- 2214-6237 (ISSN-L)
- PMC
- PMC5691219
- OpenAlex
- W2764208095
- Cited by
- 33
- References
- 21
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 6 · 2018: 1
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical & Translational Endocrinology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, children, insulin requirement, mixed meal, postprandial hyperglycemia, diabetes duration, total daily insulin dose, insulin pump therapy, sensor-augmented pump, blood glucose monitoring
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