The calculation of mealtime insulin doses is primarily based on the carbohydrate content of the meal because carbohydrate has the largest effect on postprandial blood glucose levels among the macronutrients. However, the fat and protein content of the meal can also influence postprandial blood glucose levels. In people with T1D, increasing the protein and/or fat content of a carbohydrate-containing meal increases postprandial blood glucose levels 2–5 hours after consumption[1] in a seemingly dose-dependent manner,[2][3] which necessitates additional insulin. It’s unclear how much more insulin is needed to optimize blood glucose control following a mixed meal containing large amounts of fat and protein, as it significantly varies between individuals.[1][4]
In studies that compared a low-carbohydrate diet (50–100 grams of carbohydrate per day) to a high-carbohydrate diet (205–245 grams of carbohydrate per day), total daily insulin dose was lower with the low-carbohydrate diet.[5][6][7]
References
- ^Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HAImpact 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-Jun)
- ^Paterson MA, Smart CEM, Lopez PE, Howley P, McElduff P, Attia J, Morbey C, King BRIncreasing the protein quantity in a meal results in dose-dependent effects on postprandial glucose levels in individuals with Type 1 diabetes mellitus.Diabet Med.(2017-06)
- ^Kirstine J Bell, Chantelle Z Fio, Stephen Twigg, Sally-Anne Duke, Gregory Fulcher, Kylie Alexander, Margaret McGill, Jencia Wong, Jennie Brand-Miller, Garry M SteilAmount and Type of Dietary Fat, Postprandial Glycemia, and Insulin Requirements in Type 1 Diabetes: A Randomized Within-Subject TrialDiabetes Care.(2020 Jan)
- ^Bell KJ, Toschi E, Steil GM, Wolpert HAOptimized 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-Sep)
- ^Signe Schmidt, Merete B Christensen, Nermin Serifovski, Camilla Damm-Frydenberg, Jens-Erik B Jensen, Tina Fløyel, Joachim Størling, Ajenthen Ranjan, Kirsten NørgaardLow versus high carbohydrate diet in type 1 diabetes: A 12-week randomized open-label crossover studyDiabetes Obes Metab.(2019 Jul)
- ^Ranjan A, Schmidt S, Damm-Frydenberg C, Holst JJ, Madsbad S, Nørgaard KShort-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trialDiabetes Obes Metab.(2017 Oct)
- ^Jeremy D Krebs, Amber Parry Strong, Pip Cresswell, Andrew N Reynolds, Aoife Hanna, Sylvan HaeuslerA randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into accountAsia Pac J Clin Nutr.(2016)