When dosing your insulin, not only carbohydrates must be taken into account, but also fats.
People with type 1 diabetes should take into account the amount of fat in a meal, as well as their carbohydrate content, by calculating their dose of insulin, according to the new findings.
"The dosing of the insulin for food must be based not only on the content of carbohydrates, but on the composition of the food," Dr. Howard Wolpert from the Joslin Diabetes Center in Boston, one of the authors of the study,He told Reuters Health."What implies a change in the way we approach dosing for meals."
"The adjustment is necessary when a meal contains at least 40 grams of fat, he added, and the tight dose should be distributed over time instead of giving everything at once, because fat can delay gastric emptying."
Studies have shown that both fat and proteins can cause postprandial hyperglycemia, Dr. Wolpert and his team stood out in their report, published “On Line” on July 7 in Care Diabetes.However, there are few data on how patients should adjust insulin according to the amount of fat or protein in a meal, they add.
The researchers observed differences in postprandial blood glucose for a period of six hours when 10 adults with type 1 diabetes consumed a low -fat meal, protein low (LFLP) and meals with a high protein content and rich in fat (HFHP),both covered by the same dose of insulin.The participants in the study later repeated the HFHP food using an adaptive predictive bolus (MPB) of insulin.All patients in this trial were insulin pump users.
When patients received the same insulin dose with HFHP food, the increase in the area under the low curve was produced compared to LFLP food (27,092 vs. 13,320 mg/dl per min).
The dose adjustment to achieve glycemic control objectives with HFHP food requires, on average, a 65% increase in the insulin dose, although the additional amount varied widely among the study participants, from 17% to 124%.
Most of the increase related to glucose fat occurred 80 minutes after food.
"An important investigation limitation in the past is that researchers have assumed that all people need the same increase in insulin by eating a high food in fat" Dr. Wolpert pointed out.
"There is a great interindividual variation in the effect of fat in the insulin requirement of people, so dosing requirements must be individualized," he said.
Proteins have a lower impact on glucose after meals, according to Dr. Wolpert, and does not require adjustment of insulin dose only with meals containing at least 75 grams of protein.
Dr. Wolpert is currently working on the development of tools based on smartphones to provide insulin dosing orientation based on the macronutrient content of a meal.
Source: Care Diabetes
