The Effect of Prandial Insulin Applied for Fat Protein Units on Postprandial Glucose Excursions in Type 1 Diabetes Patients with Insulin Pump Therapy: Results of a Randomized, Controlled, Cross-Over Study

Abstract

Objective This randomized cross-over study aimed to compare different algorithms for calculating prandial insulin considering the fat and protein content of a standardized meal in type 1 diabetes patients using insulin pump therapy (CSII).

Methods Twenty-six patients received a standardized evening meal for three consecutive days using different algorithms for insulin dose adjustment: A) exclusive consideration of carbohydrate content without considering fat-protein content, B) high-dose algorithm considering additional insulin for fat protein units (FPUs) with the same factor as for carbohydrates, and C) low-dose algorithm considering additional insulin for FPUs with half the factor as for carbohydrates. The primary outcome was the proportion of interstitial glucose values in the target range (≥ 70 to ≤ 180 mg/dl) during the post-prandial 12-hour follow-up period. Secondary outcomes were the occurrence of hypo- and hyperglycemic episodes and the coverage with carbohydrates for treatment of hypoglycemia.

Results The percentage of glucose values in the target range was significantly higher when fat-protein content was not considered, whereas, in the hyperglycemic range, it did not differ significantly among the three groups. The percentage of hypoglycemic glucose values were the highest in the groups considering fat-protein content and lowest in the group not considering FPUs with no significant difference between the two groups in terms of FPUs.

Conclusions In adult type 1 diabetes patients using CSII, it is not recommended to consider a high fat and protein content in the diet when calculating prandial insulin dosage with the selected algorithms, as this increases the risk of hypoglycemia disproportionately.

Key words

type 1 diabetes - insulin pump therapy - insulin calculation - fat protein units

^* E. Herrmann actually is affiliated with Medicover Oldenburg MVZ.

Publication History

Received: 16 September 2020
Received: 13 March 2021

Accepted: 17 March 2021

Article published online:
20 April 2021

• References

• 1 American Diabetes Association (ADA). 1. Improving care and promoting health in populations: Standards of medical care in diabetes – 2020. Diabetes Care 2020; 43: S7-13
• 2 Haak T, Gölz S, Fritsche A. et al. Therapy of Type 1 Diabetes. Abridged Version of the S3 Guideline (AWMF Register 2nd Edition). Exp Clin Endocrinol Diabetes 2019; 127: S27-38
• 3 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: 1008-1015
• 4 Carstensen S. Postprandiale blutglukoseverläufe in der (Insulinpumpen-) therapie des typ-1-diabetes. Einfluss der nahrungsbestandteile fett und eiweiß. Diabetologe 2012; 8: 213-221
• 5 García-López JM, González-Rodriguez M, Pazos-Couselo M. et al. Should the amounts of fat and protein be taken into consideration to calculate the lunch prandial insulin bolus? Results from a randomized crossover trial. Diabetes Technol Ther 2013; 15: 166-171
• 6 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: 3897-3902
• 7 Pickup JC. Is insulin pump therapy effective in Type 1 diabetes?. Diabetic Med 2019; 36: 269-278
• 8 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: 810-816
• 9 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
• 10 Russell WR, Baka A, Björck I. et al. Impact of diet composition on blood glucose regulation. Crit Rev Food Sci Nutr 2016; 56: 541-590
• 11 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: 571-576
• 12 Błazik M, Pańkowska E. The effect of bolus and food calculator Diabetics on glucose variability in children with type 1 diabetes treated with insulin pump: the results of RCT. Pediatr Diabetes 2012; 13: 534-539
• 13 Pankowska E, Blazik 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
• 14 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: 540-544
• 15 Lee SW, Cao M, Sajid S. et al. The dual-wave bolus feature in continuous subcutaneous insulin infusion pumps controls prolonged post-prandial hyperglycaemia better than standard bolus in Type 1 diabetes. Diabetes Nutr Metab 2004; 17: 211-216
• 16 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: 1593-1603