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

M. Evans, C. E. M. Smart, N. Paramalingam, G. J. Smith, T. W. Jones, B. R. King, E. A. Davis

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Abstract

Aim To quantify the insulin requirement for a high-protein meal compared with a low-protein meal, controlling for carbohydrate and fat content. Methods In 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. Results A total of 11 participants (mean +/- sd age 16.5 +/- 2.7 years, HbA(1c) 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. Conclusions A high-protein meal requires similar to 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.

Original languageEnglish
Pages (from-to)499-504
Number of pages6
JournalDiabetic Medicine
Volume36
Issue number4
DOIs
Publication statusPublished - Apr 2019

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