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[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.



 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/dLbmin; 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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