Title

For a high fat- high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with Type 1 diabetes using multiple daily injections: a cross-over trial
January 9, 2021
Citation: Diabet Med. 2021 Jan 9 e14512 [Epub ahead of print]

AIM To determine the glycaemic impact of an increased insulin dose, split insulin dose and regular insulin for a high fat, high protein breakfast in people with type 1 diabetes using multiple daily injections (≥4/day).
METHODS In this cross-over trial, participants received the same high fat, high protein breakfast (carbohydrate:30g, fat:40g, protein:50g) on four days. Four different insulin strategies were randomly allocated and tested; 100% of the insulin-to-carbohydrate ratio (ICR) given in a single dose using aspart insulin (100Asp), 125%ICR given in a single dose using aspart (125Asp) or regular insulin (125Reg) and 125%ICR given in a split dose using aspart insulin (100:25Asp). Insulin was given 0.25 hr pre-meal and for 100:25Asp, also 1 hr post-meal. Postprandial sensor glucose was measured for 5 hr.
RESULTS Twenty-four children and adults participated. The 5 hr incremental area under the curves for 100Asp, 125Asp, 125Reg and 100:25Asp were 620 mmol/L.min [95% CI: 451,788], 341 mmol/L.min [169,512], 675 mmol/L.min [504,847] and 434 mmol/L.min [259,608]respectively. The 5 hr incremental area under the curve for 125Asp was significantly lower than for 100Asp (p=0.016) and for 125Reg (p=0.002). There was one episode of hypoglycaemia in 125Reg.
CONCLUSIONS For a high fat, high protein breakfast, giving 125%ICR preprandially, using aspart insulin significantly improved postprandial glycaemia without hypoglycaemia. There was no additional glycaemic benefit from giving insulin in a split dose (100:25%) or replacing aspart with regular insulin.