People with type 1 diabetes are provided guidance and structured education on adjusting their mealtime bolus insulin dose based on the carbohydrate content of the meal. However, recent research in patients using continuous subcutaneous insulin infusion (CSII) and Multiple Daily Injections (MDI) has highlighted the role of dietary fat in increasing prandial insulin requirements, particularly late into the postprandial period. The average daily amount of fat consumed as part of a westernised diet typically exceeds ~80g, with some habitual meals often consuming up to 50g of fat. Following intestinal absorption, fats ingested in the meal appear in the blood predominantly as triglycerides (TG; termed postprandial lipaemia), reaching a peak 3-4 hours' post-consumption before gradually decreasing. Prolonged and exaggerated postprandial lipaemia significantly increases CVD risk. TGs are transported in lipoproteins (chylomicrons and VLDL, and their respective remnants), which upon entry to the circulation undergo dynamic remodelling which is largely atherogenic. Thus, people with type 1 diabetes following westernised diets and using only the carbohydrate counting method for mealtime insulin dosing are likely exposed to a repeated pattern of prolonged and exaggerated postprandial glycaemia, lipaemia, and cardiovascualr risk. In this session, we will discuss novel strategies regarding insulin dosing for real meals.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology