Additional Insulin Is Required in Both the Early and Late Postprandial Periods for Meals High in Protein and Fat: A Randomized Trial

Barbara Keating, Carmel E. Smart, Amelia J. Harray, Nirubasini Paramalingam, Timothy Jones, Grant J. Smith, Bruce R. King, Elizabeth Davis

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Context: The pattern and quantity of insulin required for high protein high fat (HPHF) meals is not well understood.

Objective: This study aimed to determine the amount and delivery pattern of insulin required to maintain euglycaemia for five hours after consuming a HPHF meal compared to a low protein low fat (LPLF) meal.

Design: Randomised cross-over clinical trial.

Setting: Two Australian paediatric diabetes centres.

Participants: 12 - 21 year olds (n=10) with type 1 diabetes ≥1 year.

Intervention(s): Participants were randomised to HPHF meal (60g protein, 40g fat) or LPLF meal (5g protein, 5g fat) with identical carbohydrate content (30g). A modified insulin clamp technique was used to determine insulin requirements to maintain postprandial euglycaemia for five hours.

Main outcome measured: Total mean insulin requirements over five hours.

Results: 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 the HPHF meal; 0-2 hours (extra 1.2 (CI 0.6, 1.6) units/hr), 2-4 hours (extra 1.1 (CI 0.6,1.6) units/hr) and 4-5 hours (extra 0.6 (CI 0.1,1.1) units/hr) 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 two hours).

Conclusions: The addition of protein and fat to a standardised carbohydrate meal almost doubled the mean insulin requirement, with most participants requiring half of the additional insulin in the first two hours.

Keywords: Fat; Glycaemia; Insulin; Postprandial Period; Protein; Type 1 Diabetes.
Original languageEnglish
Pages (from-to)E3611-E3618
JournalThe Journal of Clinical Endocrinology & Metabolism
Issue number9
Publication statusPublished - 1 Sept 2021


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