ESPE Abstracts (2018) 89 P-P1-077

Additional Insulin is Necessary to Prevent Rise in Blood Glucose after Fat-protein-rich Meals in Type 1 Diabetes

Roland Schweizera, Susann Herrlichb, Martina Lösch-Binderb, Michaela Glöklerb, Magdalena Heimgärtnerb, Franziska Liebrichb, Katja Meßnerb,c, Tina Muckenhauptc, Angelika Schneiderb, Julian Zieglera & Andreas Neub

aPediatric Endocrinology and Diabetology, Tübingen, Germany; bPediatric Diabetology, Tübingen, Germany; cChildren’s Hospital, Reutlingen, Germany

Background: High amounts of protein in meals increase blood glucose in patients with type 1 diabetes. Fat delays the increase of blood glucose. Till now we do not know the amount of insulin necessary to prevent the increase of blood glucose after a fat and protein rich meal (FPRM).

Aim: To find the Insulin dosage to normalize glucose level after a FPRM.

Patients: Sixteen patients with type 1 diabetes (mean±SD; Age 19.7±2.7 years; diabetes duration 12.0±5.7 years; HbA1c 7.4±0.75%).

Methods: Application of a FPRM as evening meal (carbohydrates 57.2 g; protein 92.4 g; fat 38.8 g; fibers 7.2 g; calories 974.2 kcal) with additional 20% or 40% more Insulin compared to a standard meal (SM; carbohydrates 70 g; protein 28 g; fat 19 g; fibers 10 g; calories 560 kcal) or carbohydrates only. Insulin was administered as regular insulin for patients with ICT or as a 4 hours delayed bolus in patients on pump therapy. Recording of glucose levels during 12 hours after the meal was carried out with CGM (Enlite-Sensors, Medtronic Corporation). Comparison of Glucose levels between FPRM and SM and calculation of additional insulin amount based on 100 g of proteins as a multiple of the carbohydrate unit.

Results: Glucose levels (median, mg/dl) 12 hours after the meal with 20% vs. 40% vs. dose for SM was 103.5 vs. 103.0 vs. 82.0. Glucose-AUC during 12 hours after the meal with 20% vs. 40% vs. dose for SM was 1489 vs. 1488 vs. 1415 mg/dl/12 h (no significant differences). Glucose levels in the target range with 20% vs. 40% more Insulin were 60% vs. 69% (Chi-Square-Test, P<0.01). Glucose levels <60 mg/dl did not increase by use of 40% more Insulin. This corresponds to the 2.15 fold carbohydrate unit for 100 g Protein.

Conclusion: To normalize glucose levels after a FPRM we recommend the extra administration of double the dose used per one carbohydrate unit for 100 g protein. We therefore suggest giving additional Insulin corresponding to that amount after a FPRM.