Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, New South Wales, Australia Joslin Diabetes Center, Boston, MA.
Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA.
Diabetes Care. 2016 Sep;39(9):1631-4. doi: 10.2337/dc15-2855. Epub 2016 Jul 7.
To determine insulin dose adjustments required for coverage of high-fat, high-protein (HFHP) meals in type 1 diabetes (T1D).
Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive model-predictive insulin bolus until target postprandial glycemic control was achieved.
With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320 ± 2,960 vs. 27,092 ± 1,709 mg/dL ⋅ min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%-124%) with a 30%/70% split over 2.4 h.
This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.
确定 1 型糖尿病（T1D）患者摄入高脂肪、高蛋白（HFHP）膳食时所需的胰岛素剂量调整。
10 名 T1D 成人接受了含有相同碳水化合物含量的低脂肪、低蛋白（LFLP）和 HFHP 膳食，并给予相同的胰岛素剂量覆盖。在随后的时间里，受试者用适应性模型预测性胰岛素推注重复 HFHP 膳食，直到达到目标餐后血糖控制。
相同的胰岛素剂量下，HFHP 使血糖增量曲线下面积增加了两倍多（13320±2960 与 27092±1709mg/dL ⋅ min；P=0.0013）。为了在 HFHP 后达到目标血糖控制，需要增加 65%的胰岛素（范围 17%-124%），在 2.4 小时内分为 30%/70%。
这项研究表明，胰岛素剂量计算除了碳水化合物含量外，还需要考虑膳食成分，并为覆盖不同宏量营养素组成的膳食的新胰岛素给药算法提供了基础。
