Influence of and Optimal Insulin Therapy for a Low–Glycemic Index Meal in Children With Type 1 Diabetes Receiving Intensive Insulin Therapy

Ryan, Rochelle L.; King, Bruce R.; Anderson, Donald G.; Attia, John; Collins, Clare E.; Smart, Carmel E.

doi:10.2337/dc08-0331

Cited by 60 publications

(64 citation statements)

References 25 publications

(19 reference statements)

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“…[14] This study is limited in that only 5 subjects were involved. Further studies are required to determine the optimal ratios of insulin, insulin delivery options and non-insulin-related strategies for managing PPBG.…”

Section: Discussionmentioning

confidence: 99%

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio

et al. 2013

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Background. Postprandial glucose excursions contribute significantly to average blood glucose, glycaemic variability and cardiovascular risk. Carbohydrate counting is a method of insulin dosing that balances carbohydrate load to insulin dose using a fixed ratio. Many patients and current insulin pumps calculate insulin delivery for meals based on a linear carbohydrate-to-insulin relationship. It is our hypothesis that a non-linear relationship exists between the amounts of carbohydrate consumed and the insulin required to cover it. Aim. To document blood glucose exposure in response to increasing carbohydrate loads on fixed carbohydrate-to-insulin ratios. Methods. Five type 1 diabetic subjects receiving insulin pump therapy with good control were recruited. Morning basal rates and carbohydrateto-insulin ratios were optimised. A Medtronic glucose sensor was used for 5 days to collect data for area-under-the-curve (AUC) analysis, during which standardised meals of increasing carbohydrate loads were consumed. Results. Increasing carbohydrate loads using a fixed carbohydrate-to-insulin ratio resulted in increasing glucose AUC. The relationship was found to be exponential rather than linear. Late postprandial hypoglycaemia followed carbohydrate loads of >60 g and this was often followed by rebound hyperglycaemia that lasted >6 hours. Conclusion. A non-linear relationship exists between carbohydrates consumed and the insulin required to cover them. This has implications for control of postprandial blood sugars, especially when consuming large carbohydrate loads. Further studies are required to look at the optimal ratios, duration and type of insulin boluses required to cover increasing carbohydrate loads.

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Section: Discussionmentioning

confidence: 99%

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio

et al. 2013

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“…GI c Seven studies (total 98 subjects) (4,6,(8)(9)(10)12,14). c All studies reported significant differences in glycemia with differing GI (same carbohydrate).…”

Section: Glycemic Indexmentioning

confidence: 99%

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

et al. 2015

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BACKGROUNDContinuous glucose monitoring highlights the complexity of postprandial glucose patterns present in type 1 diabetes and points to the limitations of current approaches to mealtime insulin dosing based primarily on carbohydrate counting. METHODSA systematic review of all relevant biomedical databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, was conducted to identify research on the effects of dietary fat, protein, and glycemic index (GI) on acute postprandial glucose control in type 1 diabetes and prandial insulin dosing strategies for these dietary factors. RESULTSAll studies examining the effect of fat (n = 7), protein (n = 7), and GI (n = 7) indicated that these dietary factors modify postprandial glycemia. Late postprandial hyperglycemia was the predominant effect of dietary fat; however, in some studies, glucose concentrations were reduced in the first 2-3 h, possibly due to delayed gastric emptying. Ten studies examining insulin bolus dose and delivery patterns required for high-fat and/or high-protein meals were identified. Because of methodological differences and limitations in experimental design, study findings were inconsistent regarding optimal bolus delivery pattern; however, the studies indicated that high-fat/protein meals require more insulin than lower-fat/protein meals with identical carbohydrate content. CONCLUSIONSThese studies have important implications for clinical practice and patient education and point to the need for research focused on the development of new insulin dosing algorithms based on meal composition rather than on carbohydrate content alone.

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“…16,[29][30][31][32] Yoğun insülin tedavisi alan Tip 1 diyabetlilerde, Gİ'nin postprandiyal glisemi üzerine etkisinin incelendiği çalışmalarda, yüksek Gİ'li besinler veya öğünlerle düşük Gİ'li besinler veya öğünler karşılaştırılmış, diyet ile Gİ'nin düşürül-mesinin daha iyi glisemik kontrol sağladığı bildirilmiştir. 2,16,[29][30][31][32]35 Mohammed ve ark., eğri altındaki artış alanı-nın Gİ ile yakından ilişkili olduğunu saptamışlar-dır. Yüksek Gİ'li öğün, düşük Gİ'li öğünle karşılaştırıldığında 30. ve 180. dk arasındaki bütün zaman noktalarında daha yüksek postprandiyal glukoz seyrine neden olmuştur.…”

Section: Gli̇semi̇k İndeksi̇n Postprandi̇yal Gli̇semi̇ üZeri̇ne Etki̇si̇unclassified

“…7 Optimal prandiyal bolus zamanını araştıran çalışmalarda, insülin dozunun öğüne başlamadan önce uygulanmasının geciktirilmesiyle karşılaştı-rıldığında daha iyi bir glisemik kontrol sağladığı belirtilmektedir. [35][36][37] Smart ve ark., yağ içeriği yük-sek öğün tüketimi sonrası ani postprandiyal glukoz yükselişi zayıf olsa da öğünün karbonhidrat içeriği için hâlâ insülin ihtiyacı bulunduğunu bildirmiş-lerdir. Bu nedenle, yüksek yağlı öğünlerde insülin enjeksiyonunun geciktirilmesinin istenmeyen postprandiyal hiperglisemiye yol açabileceği ifade edilmektedir.…”

Section: Di̇yet Yağ Ve Protei̇nleri̇ İçi̇n İnsüli̇n Bolus Dozu Bolus Zamaunclassified

“…35 Pompa tedavisi uygulanan hastalar üzerinde yapılan bir çalışmada, düşük Gİ'li öğün-lerde çift dalga bolus uygulaması (%50'si hızlı bir şekilde, %50'si 2 saate yayarak) standart bolusla karşılaştırıldığında, eğri altındaki postprandiyal glukoz alanını (AUC) %47 azalttığı görülmüştür. 34 Başka bir çalışmada ise yüksek Gİ'li öğünler için bolus dozu hesaplamasında, karbonhidrat/insülin oranının %30 artırılmasının hipoglisemi riskini artırmadan postprandiyal insülin yanıtını iyileştirdiği belirtilmektedir.…”

Section: Gli̇semi̇k İndeks İçi̇n İnsüli̇n Bolus Dozunun Bolus Zamani Ve unclassified

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The Effect of Fat, Protein and Glycemic Index on Blood Glucose in Type 1 Diabetes and Their Usage in Insulin Administration: Review

Bozbulut¹,

Şanlıer²

2016

Turkiye Klinikleri J Endocrin

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Influence of and Optimal Insulin Therapy for a Low–Glycemic Index Meal in Children With Type 1 Diabetes Receiving Intensive Insulin Therapy

Cited by 60 publications

References 25 publications

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio

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

The Effect of Fat, Protein and Glycemic Index on Blood Glucose in Type 1 Diabetes and Their Usage in Insulin Administration: Review

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