In young people using insulin pump therapy an additional sixty percent of the mealtime insulin dose improves postprandial glycaemia following a high fat, high protein meal

Abstract

Research has demonstrated the need for additional insulin for fat and protein rich meals in individuals with Type 1 Diabetes (T1D). However, current insulin dosing algorithms for fat and protein have been associated with an increased rate of hypoglycaemia. We aimed to determine the amount of additional insulin required for a high fat, high protein meal (HFHP) to optimize postprandial glycaemia without increasing the incidence of hypoglycaemia in young people with T1D using insulin pump therapy. This is a four-by-four randomized, crossover trial being conducted at two pediatric centers in Australia. Presented are the results of an initial 7 subjects; mean age 13.3 ± 3.8 years (4 male), diabetes duration 4.8 ± 4.1 years, and HbA1c 49 mmol/mol (6.7 ± 0.7%). Following an overnight fast, subjects were given the same high fat (40g), high protein (50g), moderate carbohydrate (30g) meal with insulin on 4 occasions. On each occasion, insulin was calculated for the carbohydrate content of the meal with an additional 0% (control), 20%, 40% or 60% of this dose added to give the total dose. The total dose was delivered as a combination bolus, 60% was delivered in a standard bolus 15 minutes prior to meal consumption with the remaining 40% delivered in an extended bolus over 3 hours. Postprandial glycaemia was assessed for 5 hours using continuous glucose monitoring. Administration of an additional 60% of the mealtime insulin dose for a HFHP meal resulted in significantly lower mean postprandial glucose excursions from 60- 270 minutes (p< 0.05) when compared to the control condition, 0% (Figure 1). There were 2 hypoglycemic episodes (BGL ≤3.5 mmol/L), 1 episode occurred in the 40% and 60% condition respectively. Preliminary study results have demonstrated that for a HFHP meal an additional 60% of the mealtime insulin dose improves postprandial glycaemia without increasing the incidence of hypoglycaemia. (Figure Presented) .L6266837182019-03-14 <br />