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Re: [IP] Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management.



Yerachmiel, I don't need a study to tell me that fat consumption major
affects my blood glucose levels.  And it doesn't matter if they are good or
bad fats.  I eat ice cream once a week and pop corn at the movies every
once in a while.  I can't begin to tell you what these do to my readings.
The problem is that it happens after many hours (at least 8 or more, even
into the next day),so it's very hard to know when it's going to hit.  Like
last night: I had a scoop of regular ice cream at 2:30 in the afternoon.
Everything went well, had dinner, a snack before bed and woke up low at
1:30 am.  Had a snack which I carb factored and took insulin for so that I
wouldn't go too high from the snack.  Had 15 carbs.  Woke up at 4:30am at
205.  Took a correction dose of insulin. Woke again at 7:30 at 185.  Took
more insulin, walked the dogs, and was finally low enough at 10:00 to have
breakfast.  There are many times that I have to ride my stationary bike to
get my bg to come down.  The same thing happens with any fat.  I eat this
stuff anyway for two reasons: I love it and am not willing to give up my
ice cream (yes, I know there are low fat ice creams) and I don't want to
get any thinner, so I feel the need to ingest some fats.

I don't know if all diabetics are so sensitive to fats or if it's just that
I watch my numbers so closely, but sometimes I wonder what the hell we're
supposed to eat.  I eat tons of fruit and vegetables and I'm just not
willing to give up the yummy food completely.  Susan


On Mon, Jan 27, 2014 at 11:14 AM, Yerachmiel Altman <
email @ redacted> wrote:

>  Diabetes Care. 2013 Apr;36(4):810-6. doi: 10.2337/dc12-0092. Epub 2012 Nov
> 27.Dietary fat acutely increases glucose concentrations and insulin
> requirements
> in patients with type 1 diabetes: implications for carbohydrate-based
> bolus dose
> calculation and intensive diabetes management.Wolpert HA, Atakov-Castillo
> A,
> Smith SA, Steil GM.Author informationAbstractOBJECTIVE:Current guidelines
> for
> intensive treatment of type 1 diabetes base the mealtime insulin bolus
> calculation exclusively on carbohydratecounting. There is strong evidence
> that
> free fatty acids impair insulin sensitivity. We hypothesized that patients
> with
> type 1 diabetes would require more insulin coverage for higher-fat meals
> than
> lower-fat meals with identical carbohydrate content.RESEARCH DESIGN AND
> METHODS:We used a crossover design comparing two 18-h periods of
> closed-loop
> glucose control after high-fat (HF) dinner compared with low-fat (LF)
> dinner.
> Each dinner had identical carbohydrate and protein content, but different
> fat
> content (60 vs. 10 g).RESULTS:Seven patients with type 1 diabetes (age, 55
> B1 12
> years; A1C 7.2 B1 0.8%) successfully completed the protocol. HF dinner
> required
> more insulin than LF dinner (12.6 B1 1.9 units vs. 9.0 B1 1.3 units; P =
> 0.01)
> and, despite the additional insulin, caused more hyperglycemia (area under
> the
> curve >120 mg/dL = 16,967 B1 2,778 vs. 8,350 B1 1,907 mg/dLb  min; P <
> 0001).
> Carbohydrate-to-insulin ratio for HF dinner was significantly lower (9 B1
> 2 vs.
> 13 B1 3 g/unit; P = 0.01). There were marked interindividual differences
> in the
> effect of dietary fat on insulin requirements (percent increase
> significantly
> correlated with daily insulin requirement; R(2) = 0.64; P =
> 0.03).CONCLUSIONS:This evidence that dietary fat increases glucose levels
> and
> insulin requirements highlights the limitations of the current
> carbohydrate-based approach to bolus dose calculation. These findings
> point to
> the need for alternative insulin dosing algorithms for higher-fat meals and
> suggest that dietary fat intake is an important nutritional consideration
> for
> glycemic control in individuals with type 1 diabetes.
> .
> Follow us at https://www.twitter.com/insulinpumpers
> Make a long URL short at http://type1.org
.
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