Dietary protein affects both the dose and pattern of insulin delivery required to achieve postprandial euglycaemia in Type 1 diabetes: a randomized trial

• DOI: 10.1111/dme.13875
• Publication Date: 2018-12-07T16:23:11Z
• Authors: M. Evans; C. E. M. Smart; N. Paramalingam; G. J. Smith; T. W. Jones; B. R. King; E. A. Davis
• Keywords: Adult; Blood Glucose; Male; 571; Adolescent; Sustainable Development Goals; insulin requirements; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Dietary Carbohydrates; Humans; Insulin; Meals; SDG 3; 2. Zero hunger; Cross-Over Studies; Dose-Response Relationship, Drug; Blood Glucose Self-Monitoring; Postprandial Period; Drug Liberation; Type 1 diabetes; Diabetes Mellitus, Type 1; carbohydrate; Glucose Clamp Technique; Female; Dietary Proteins; protein

AbstractAimTo quantify the insulin requirement for a high‐protein meal compared with a low‐protein meal, controlling for carbohydrate and fat content.MethodsIn this crossover study, young people with Type 1 diabetes were randomized to consume a high‐ (60 g) or low‐protein meal (5 g), each containing 30 g carbohydrate and 8 g fat. A variation of the insulin clamp technique was used to determine the insulin requirements to maintain euglycaemia for the following 5 h.ResultsA total of 11 participants (mean ± sd age 16.5 ± 2.7 years, HbA1c 52 ± 8.7 mmol/mol [6.9 ± 0.8%], diabetes duration 6.9±5.1 years) completed the study. The mean insulin requirements for the high‐protein meal were higher than for the low‐protein meal [10.3 (CI 8.2, 12.57) vs 6.7 units (CI 4.7, 8.8); P=0.001], with inter‐individual requirements ranging from 0.9 to six times the low‐protein meal requirement. Approximately half the additional insulin [1.1 units/h (CI 0.5, 1.8; P=0.001)] was given in the first 2 h, compared with an additional 0.5 units/h (CI –0.2, 1.2; P=0.148) in the second 2 h and 0.1 units (CI –0.6, 0.8; P=0.769) in the final hour.ConclusionsA high‐protein meal requires ~50% more insulin to maintain euglycaemia than a low‐protein meal that contains the same quantity of carbohydrate. The majority is required within the first 2 h. Inter‐individual differences exist in insulin requirements for dietary protein.