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How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?

Yıl 2023, Cilt: 36 Sayı: 2, 242 - 248, 31.05.2023

Öz

Objective: In this study, it was aimed to evaluate the effects of an additional insulin dose for high-fat and high-protein meal on blood
glucose levels in adolescents with type 1 diabetes.
Patients and Methods: This study was single-center, crossover, and randomized. Seven adolescents with type 1 diabetes between the
ages of 14 and 17 were given breakfast containing high-fat (45.9% energy) and high-protein (21.9% energy) for two consecutive days,
and two different insulin doses were administered. According to the first application dose of carbohydrate/insulin ratio, the second
application was given this dose of additional insulin up to 30% in postprandial 180th minute. Blood glucose was monitored for 360
minutes at 30-minute intervals using a continuous glucose monitoring system (CGMS).
Results: The average time spent in the target range (TIR) of participants was 30.6±11.83%, and time spent in hyperglycemia and
hypoglycemia (time above range (TAR) and time below range (TBR)) were 67.0±14.31% and 2.4±4.89%, respectively. There was no
statistically significant difference between the early (0-120th min), late (120-360th min), and total (0-360th min) glycemic responses of
the applications (p>0.05). According to CGMS result, mean blood glucose, glycemic variability, and absolute blood glucose difference
median and mean absolute deviation (MAD%) were found to be similar after two applications (p>0.05).
Conclusion: Insulin dose applications should be individually calculated to prevent delayed-prolonged postprandial hyperglycemia
caused by high-fat high – protein intake in adolescents with type 1 diabetes.

Kaynakça

  • [1] Bluestone JA, Herold K, Eisenbarth G. Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature 2010; 464:1293-300. doi: 10.1038/nature08933
  • [2] Cameron FJ, Garvey K, Hood KK, et al. ISPAD clinical practice consensus guidelines 2018: diabetes in adolescence. Pediatr Diabetes 2018; 19:250-61. doi: 10.1111/pedi.12702.
  • [3] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2020. Diabetes Care 2020; 43:S1- 224. doi: 10.2337/dc20-S006.
  • [4] American Diabetes Association. 4. Lifestyle management: standards of medical care in diabetes-2018. Diabetes Care 2018; 41:S38-50. doi: 10.2337/dc18-S004.
  • [5] Brazeau A, Mircescu H, Desjardins K, et al. Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes. Diabetes Res Clin Pract 2013; 9919-23. doi: 10.1016/j.diabres.2012.10.024.
  • [6] Mehta SN, Quinn N, Volkening LK, et al. Impact of carbohydrate counting on glycemic control in children with type 1 diabetes. Diabetes Care 2009; 32:1014-6. doi: 10.2337/ dc08-2068.
  • [7] Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 2012; 14:16-22. doi: 10.1089/ dia.2011.0083.
  • [8] Peters AL, Davidson MB. Protein and fat effects on glucose responses and insulin requirements in subjects with insulindependent diabetes mellitus. Am J Clin Nutr 1993; 58:555-60. doi: 10.1093/ajcn/58.4.555.
  • [9] Smart CE, Evans M, O’connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 2013; 36:3897-902. doi: 10.2337/dc13-1195.
  • [10] Wolpert HA, Atakov-Castillo A, Smith SA, et al. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 2013; 36:810-6. doi: 10.2337/dc12-0092.
  • [11] Kordonouri O, Hartmann R, Remus K, et al. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatr Diabetes 2012; 13:540-4. doi: 10.1111/j.1399-5448.2012.00880.x.
  • [12] Paterson M, Bell KJ, O’Connell SM, et al. The role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Curr Diab Rep 2015; 15:61. doi: 10.1007/s11892.015.0630-5.
  • [13] Piechowiak K, Dżygało K, Szypowska A. The additional dose of insulin for high‐protein mixed meal provides better glycemic control in children with type 1 diabetes on insulin pumps: randomized cross‐over study. Pediatr Diabetes 2017; 18:861-8. doi: 10.1111/pedi.12500.
  • [14] Bloomgarden Z. Beyond HbA1c. J Diabetes 2017; 9:1052. doi: 10.1111/1753-0407.12590.
  • [15] Rama Chandran S, Tay WL, Lye WK, et al. Beyond HbA1c: comparing glycemic variability and glycemic indices in predicting hypoglycemia in type 1 and type 2 diabetes. Diabetes Technol Ther 2018; 20:353-62. doi: 10.1089/dia.2017.0388.
  • [16] Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care 2019; 42:400-5. doi: 10.2337/dc18-1444.
  • [17] Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019; 21:81-5. doi: 10.1089/dia.2018.0310.
  • [18] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019; 42:1593-603. doi: 10.2337/ dci19-0028.
  • [19] Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, et al. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐analysis. Diabet Med 2013; 30:189-98. doi: 10.1111/j.1464-5491.2012.03771.x.
  • [20] Abdou M, Hafez MH, Anwar GM, et al. Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes Metab Syndr 2021; 15:7-12. doi: 10.1016/j.dsx.2020.11.020.
  • [21] Keating B, Smart CEM, Harray AJ, et al. Additional insulin is required in both the early and late postprandial periods for meals high in protein and fat: a randomized trial. J Clin Endocrinol Metab 2021; 106: e3611-8. doi: 10.1210/clinem/ dgab318.
  • [22] Roden M, Price TB, Perseghin G, et al. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Investig 1996; 97:2859-65. doi: 10.1172/JCI118742.
  • [23] Bell K, Gray R, Munns D, et al. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr 2014; 68:1055-9. doi: 10.1038/ejcn.2014.126.
  • [24] Bell KJ, Smart CE, Steil GM, et al. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38:1008-15. doi: 10.2337/dc15-0100.
  • [25] Bell KJ, Toschi E, Steil GM, et al. Optimized mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management. Diabetes Care 2016; 39:1631-4. doi: 10.2337/dc15-2855.
  • [26] Pańkowska E, Błazik M. Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. J Diabetes Sci Technol 2010; 4:571-6. doi: 10.1177/193.229.681000400310.
  • [27] Pańkowska E, Szypowska A, Lipka M, et al. Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes. Pediatr Diabetes 2009; 10:298-303. doi: 10.1111/j.1399-5448.2008.00471.x.
  • [28] Mendes RH, Hagen MEK, Barp J, et al. Isolated soy proteinbased diet ameliorates glycemia and antioxidants enzyme activities in streptozotocin-induced diabetes. FNS 2014; 5:2089-96. doi: 10.4236/fns.2014.521221.
  • [29] Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009; 373:2027-33. doi: 10.1016/ S0140-6736(09)60568-7.
  • [30] Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive oil reduces glycemic response to a high–glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care 2016; 39:518-24. doi: 10.2337/dc15-2189.
  • [31] Maffeis C, Morandi A, Ventura E, et al. Diet, physical, and biochemical characteristics of children and adolescents with type 1 diabetes: relationship between dietary fat and glucose control. Pediatr Diabetes 2012; 13:137-46. doi: 10.1111/j.1399- 5448.2011.00781.x.
Yıl 2023, Cilt: 36 Sayı: 2, 242 - 248, 31.05.2023

Öz

Kaynakça

  • [1] Bluestone JA, Herold K, Eisenbarth G. Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature 2010; 464:1293-300. doi: 10.1038/nature08933
  • [2] Cameron FJ, Garvey K, Hood KK, et al. ISPAD clinical practice consensus guidelines 2018: diabetes in adolescence. Pediatr Diabetes 2018; 19:250-61. doi: 10.1111/pedi.12702.
  • [3] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2020. Diabetes Care 2020; 43:S1- 224. doi: 10.2337/dc20-S006.
  • [4] American Diabetes Association. 4. Lifestyle management: standards of medical care in diabetes-2018. Diabetes Care 2018; 41:S38-50. doi: 10.2337/dc18-S004.
  • [5] Brazeau A, Mircescu H, Desjardins K, et al. Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes. Diabetes Res Clin Pract 2013; 9919-23. doi: 10.1016/j.diabres.2012.10.024.
  • [6] Mehta SN, Quinn N, Volkening LK, et al. Impact of carbohydrate counting on glycemic control in children with type 1 diabetes. Diabetes Care 2009; 32:1014-6. doi: 10.2337/ dc08-2068.
  • [7] Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 2012; 14:16-22. doi: 10.1089/ dia.2011.0083.
  • [8] Peters AL, Davidson MB. Protein and fat effects on glucose responses and insulin requirements in subjects with insulindependent diabetes mellitus. Am J Clin Nutr 1993; 58:555-60. doi: 10.1093/ajcn/58.4.555.
  • [9] Smart CE, Evans M, O’connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 2013; 36:3897-902. doi: 10.2337/dc13-1195.
  • [10] Wolpert HA, Atakov-Castillo A, Smith SA, et al. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 2013; 36:810-6. doi: 10.2337/dc12-0092.
  • [11] Kordonouri O, Hartmann R, Remus K, et al. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatr Diabetes 2012; 13:540-4. doi: 10.1111/j.1399-5448.2012.00880.x.
  • [12] Paterson M, Bell KJ, O’Connell SM, et al. The role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Curr Diab Rep 2015; 15:61. doi: 10.1007/s11892.015.0630-5.
  • [13] Piechowiak K, Dżygało K, Szypowska A. The additional dose of insulin for high‐protein mixed meal provides better glycemic control in children with type 1 diabetes on insulin pumps: randomized cross‐over study. Pediatr Diabetes 2017; 18:861-8. doi: 10.1111/pedi.12500.
  • [14] Bloomgarden Z. Beyond HbA1c. J Diabetes 2017; 9:1052. doi: 10.1111/1753-0407.12590.
  • [15] Rama Chandran S, Tay WL, Lye WK, et al. Beyond HbA1c: comparing glycemic variability and glycemic indices in predicting hypoglycemia in type 1 and type 2 diabetes. Diabetes Technol Ther 2018; 20:353-62. doi: 10.1089/dia.2017.0388.
  • [16] Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care 2019; 42:400-5. doi: 10.2337/dc18-1444.
  • [17] Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019; 21:81-5. doi: 10.1089/dia.2018.0310.
  • [18] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019; 42:1593-603. doi: 10.2337/ dci19-0028.
  • [19] Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, et al. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐analysis. Diabet Med 2013; 30:189-98. doi: 10.1111/j.1464-5491.2012.03771.x.
  • [20] Abdou M, Hafez MH, Anwar GM, et al. Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes Metab Syndr 2021; 15:7-12. doi: 10.1016/j.dsx.2020.11.020.
  • [21] Keating B, Smart CEM, Harray AJ, et al. Additional insulin is required in both the early and late postprandial periods for meals high in protein and fat: a randomized trial. J Clin Endocrinol Metab 2021; 106: e3611-8. doi: 10.1210/clinem/ dgab318.
  • [22] Roden M, Price TB, Perseghin G, et al. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Investig 1996; 97:2859-65. doi: 10.1172/JCI118742.
  • [23] Bell K, Gray R, Munns D, et al. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr 2014; 68:1055-9. doi: 10.1038/ejcn.2014.126.
  • [24] Bell KJ, Smart CE, Steil GM, et al. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38:1008-15. doi: 10.2337/dc15-0100.
  • [25] Bell KJ, Toschi E, Steil GM, et al. Optimized mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management. Diabetes Care 2016; 39:1631-4. doi: 10.2337/dc15-2855.
  • [26] Pańkowska E, Błazik M. Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. J Diabetes Sci Technol 2010; 4:571-6. doi: 10.1177/193.229.681000400310.
  • [27] Pańkowska E, Szypowska A, Lipka M, et al. Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes. Pediatr Diabetes 2009; 10:298-303. doi: 10.1111/j.1399-5448.2008.00471.x.
  • [28] Mendes RH, Hagen MEK, Barp J, et al. Isolated soy proteinbased diet ameliorates glycemia and antioxidants enzyme activities in streptozotocin-induced diabetes. FNS 2014; 5:2089-96. doi: 10.4236/fns.2014.521221.
  • [29] Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009; 373:2027-33. doi: 10.1016/ S0140-6736(09)60568-7.
  • [30] Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive oil reduces glycemic response to a high–glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care 2016; 39:518-24. doi: 10.2337/dc15-2189.
  • [31] Maffeis C, Morandi A, Ventura E, et al. Diet, physical, and biochemical characteristics of children and adolescents with type 1 diabetes: relationship between dietary fat and glucose control. Pediatr Diabetes 2012; 13:137-46. doi: 10.1111/j.1399- 5448.2011.00781.x.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Research
Yazarlar

Aylin Bayındır Gumus Bu kişi benim 0000-0002-1311-2429

Alev Keser Bu kişi benim 0000-0003-2620-6747

Zeynep Sıklar Bu kişi benim 0000-0003-0921-2694

Merih Berberoglu Bu kişi benim 0000-0003-3102-0242

Yayımlanma Tarihi 31 Mayıs 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 36 Sayı: 2

Kaynak Göster

APA Bayındır Gumus, A., Keser, A., Sıklar, Z., Berberoglu, M. (2023). How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?. Marmara Medical Journal, 36(2), 242-248. https://doi.org/10.5472/marumj.1302393
AMA Bayındır Gumus A, Keser A, Sıklar Z, Berberoglu M. How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?. Marmara Med J. Mayıs 2023;36(2):242-248. doi:10.5472/marumj.1302393
Chicago Bayındır Gumus, Aylin, Alev Keser, Zeynep Sıklar, ve Merih Berberoglu. “How Does an Additional Insulin Dose for a High-Fat, High-Protein Breakfast Affect Glysemic Response in Adolescents With Type 1 Diabetes?”. Marmara Medical Journal 36, sy. 2 (Mayıs 2023): 242-48. https://doi.org/10.5472/marumj.1302393.
EndNote Bayındır Gumus A, Keser A, Sıklar Z, Berberoglu M (01 Mayıs 2023) How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?. Marmara Medical Journal 36 2 242–248.
IEEE A. Bayındır Gumus, A. Keser, Z. Sıklar, ve M. Berberoglu, “How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?”, Marmara Med J, c. 36, sy. 2, ss. 242–248, 2023, doi: 10.5472/marumj.1302393.
ISNAD Bayındır Gumus, Aylin vd. “How Does an Additional Insulin Dose for a High-Fat, High-Protein Breakfast Affect Glysemic Response in Adolescents With Type 1 Diabetes?”. Marmara Medical Journal 36/2 (Mayıs 2023), 242-248. https://doi.org/10.5472/marumj.1302393.
JAMA Bayındır Gumus A, Keser A, Sıklar Z, Berberoglu M. How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?. Marmara Med J. 2023;36:242–248.
MLA Bayındır Gumus, Aylin vd. “How Does an Additional Insulin Dose for a High-Fat, High-Protein Breakfast Affect Glysemic Response in Adolescents With Type 1 Diabetes?”. Marmara Medical Journal, c. 36, sy. 2, 2023, ss. 242-8, doi:10.5472/marumj.1302393.
Vancouver Bayındır Gumus A, Keser A, Sıklar Z, Berberoglu M. How does an additional insulin dose for a high-fat, high-protein breakfast affect glysemic response in adolescents with type 1 diabetes?. Marmara Med J. 2023;36(2):242-8.