- Title
- Optimizing the combination insulin bolus split for a high-fat, high-protein meal in children and adolescents using insulin pump therapy
- Creator
- Lopez, P. E.; Smart, C. E.; McElduff, P.; Foskett, D. C.; Price, D. A.; Paterson, M. A.; King, B. R
- Relation
- Diabetic Medicine Vol. 34, Issue 10, p. 1380-1384
- Publisher Link
- http://dx.doi.org/10.1111/dme.13392
- Publisher
- Wiley-Blackwell Publishing
- Resource Type
- journal article
- Date
- 2017
- Description
- Aims: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. Methods: A total of 19 young people (mean age 12.9 ± 6.7 years) participated in a randomized, repeated-measures trial comparing postprandial glycaemic control across six study conditions after a high-fat and high-protein meal. A standard bolus and five different combination boluses were delivered over 2 h in the following splits: 70/30 = 70% standard /30% extended bolus; 60/40=60% standard/40% extended bolus; 50/50=50% standard/50% extended bolus; 40/60=40% standard/60% extended bolus; and 30/70=30% standard/70% extended bolus. Insulin dose was determined using the participant's optimized insulin:carbohydrate ratio. Continuous glucose monitoring was used to assess glucose excursions for 6 h after the test meal. Results: Standard bolus and combination boluses 70/30 and 60/40 controlled the glucose excursion up to 120 min. From 240 to 300 min after the meal, the glucose area under the curve was significantly lower for combination bolus 30/70 compared with standard bolus (P=0.004). Conclusions: High-fat and high-protein meals require a ≥60% insulin:carbohydrate ratio as a standard bolus to control the initial postprandial rise. Additional insulin at an insulin:carbohydrate ratio of up to 70% is needed in the extended bolus for a high fat and protein meal to prevent delayed hyperglycaemia.
- Subject
- high-fat; high-protein; bolus dose; insulin; children; adolescents
- Identifier
- http://hdl.handle.net/1959.13/1354780
- Identifier
- uon:31350
- Identifier
- ISSN:0742-3071
- Language
- eng
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