Perth Children's Hospital, Nedlands, WA, 6009, Australia.
Telethon Kids Institute, The University of Western Australia, Nedlands, WA, 6009, Australia.
J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3611-e3618. doi: 10.1210/clinem/dgab318.
The pattern and quantity of insulin required for high-protein high-fat (HPHF) meals is not well understood.
This study aimed to determine the amount and delivery pattern of insulin required to maintain euglycemia for 5 hours after consuming a HPHF meal compared with a low-protein low-fat (LPLF) meal.
This randomized crossover clinical trial, conducted at 2 Australian pediatric diabetes centers, included 10 patients (12-21 years of age) with type 1 diabetes for ≥ 1 year. Participants were randomized to HPHF meal (60 g protein, 40 g fat) or LPLF meal (5 g protein, 5 g fat) with identical carbohydrate content (30 g). A modified insulin clamp technique was used to determine insulin requirements to maintain postprandial euglycemia for 5 hours. Total mean insulin requirements over 5 hours were measured.
The total mean insulin requirements for the HPHF meal were significantly greater than for the LPLF meal (11.0 [CI 9.2, 12.8] units vs 5.7 [CI 3.8, 7.5] units; P = 0.001). Extra intravenous insulin was required for HPHF: 0 to 2 hours (extra 1.2 [CI 0.6, 1.6] units/h), 2 to 4 hours (extra 1.1 [CI 0.6, 1.6] units/h), and 4 to 5 hours (extra 0.6 [CI 0.1, 1.1] units/h) after the meal. There were marked inter-individual differences in the quantity of additional insulin (0.3 to 5 times more for HPHF) and the pattern of insulin delivery (0%-85% of additional insulin required in the first 2 hours).
The addition of protein and fat to a standardized carbohydrate meal almost doubled the mean insulin requirement, with most participants requiring half of the additional insulin in the first 2 hours.
高蛋白高脂肪（HPHF）膳食所需的胰岛素模式和剂量尚未完全明确。
本研究旨在确定与低蛋白低脂肪（LPLF）膳食相比，进食 HPHF 膳食后 5 小时内维持血糖正常所需的胰岛素量和输注模式。
这是一项在澳大利亚 2 家儿科糖尿病中心进行的随机交叉临床试验，纳入了 10 名（12-21 岁）患有 1 型糖尿病至少 1 年的患者。参与者随机分为 HPHF 膳食（60 g 蛋白质，40 g 脂肪）或 LPLF 膳食（5 g 蛋白质，5 g 脂肪），但两者的碳水化合物含量相同（30 g）。采用改良胰岛素钳夹技术确定维持餐后血糖正常 5 小时所需的胰岛素量。测量 5 小时内的总平均胰岛素需求量。
HPHF 膳食的总平均胰岛素需求量明显大于 LPLF 膳食（11.0[9.2，12.8]单位 vs. 5.7[3.8，7.5]单位；P=0.001）。HPHF 餐需要额外的静脉内胰岛素：0-2 小时（额外 1.2[0.6，1.6]单位/h）、2-4 小时（额外 1.1[0.6，1.6]单位/h）和 4-5 小时（额外 0.6[0.1，1.1]单位/h）。额外胰岛素的需求量存在显著的个体差异（HPHF 为 0.3 至 5 倍），且胰岛素输注模式也存在差异（0%-85%的额外胰岛素需要在最初 2 小时内给予）。
在标准化碳水化合物餐的基础上添加蛋白质和脂肪使平均胰岛素需求量增加近一倍，大多数参与者在最初的 2 小时内需要一半的额外胰岛素。
