Type 1 diabetes

Where’s the meat? And what’s it doing to my HbA1c?

BBQPatients require on average about 50% more insulin with a high protein meal than with a low protein meal.

A small but detailed physiological study of 11 adolescents and young adults with type 1 diabetes used an insulin clamp technique to determine their insulin requirements to maintain euglycaemia across the different meals given on two separate days, one week apart.

Overall, the mean insulin requirement for a meal with 60g protein was 10.4 units compared to 6.7 units with a meal containing only 5mg protein.

The study found the increased insulin requirement was seen immediately after the high protein meal, particularly in the first two hours, but continued for the five hours.

However there was also a large individual variation between people’s response to protein.

Co-author of the study Professor Elizabeth Davis, from the Telethon Kids Institute’s Children’s Diabetes Centre and Perth Children’s Hospital, told the limbic patients have been saying for years that they don’t understand why some meals lead to high blood glucose.

“And they probably were meals that were high protein or high in fat such as fast food and meat meals but we haven’t yet had a way to account for that or prescribe insulin in the appropriate doses.”

However more widespread use of CGM had really accelerated interest in the contribution of other macronutrients in meals to post-prandial glucose excursions.

“Suddenly both patients and health care professional have got this incredibly deep dive into minute-by minute information about glucose levels that they didn’t have before.”

“One of the implications of this study is that it’s really hard living with diabetes. There is so much to learn and even for families to adopt carbohydrate counting in an accurate and manageable fashion, it’s a big ask. It takes a lot of time and effort.”

“So the question for health care professionals is whether or not to teach our patients to account for protein as well, and balance that with the added burden for bringing another requirement into their diabetes management.”

She said there was no doubt a subset of patients who really want excellent glycaemic control and were driven by the knowledge that by doing so, they could reduce their risk of long-term complications of diabetes.

But it was perfectly reasonable that for other patients the added burden might outweigh the benefit.

“We have to be very mindful as we share this information with our patients about who we expect to take it up.”

“A really interesting finding is that although patients needed almost 50% more insulin for the meals that had a high protein content, there was a huge variation between individuals.”

“I think there’s a very strong message here about personalising our care of children with diabetes. This information won’t, in my mind, translate to a ‘one size fits all’ approach because it is about understanding, for an individual, their body’s postprandial response to protein and the amount of extra insulin they need.”

“This sort of information has got strong application to the closed loop system and the whole pipeline of technology development because the aim of those technologies is to get the best possible glucose control in diabetes with a long-term view to reducing the burden and long term complications such as heart disease, kidney disease and eye disease.”

She said there was currently a wave of enthusiasm for low carbohydrate diets among families with children with diabetes.

However excellent glycaemic control was no longer just about accounting for the carbohydrate in meals.

“People now have to understand what is in a meal in even further detail and then how to account for that in their diabetes management.”

“If you have good glycaemic control and are trying to make it excellent, these extra bits of information and extra attention to insulin dosing have the potential to give you better postprandial glucose levels which will give you a better HbA1c.”

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