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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.



I am with you Susan Lane.  Studies are for newly diagnosed diabetics; but
for us old timers, we already know all that.  Not all fats affect me the
same way: butter, cream, oils hardly do anything to me.  But pizza kills
me.  After many years of guessing how to bolus, I still just take a stab
and keep testing.  Good thing is that is not one of my favorite foods


On Mon, Jan 27, 2014 at 2:12 PM, Susan Lane <email @ redacted> wrote:

> 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.
> > .
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> .
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