The impact of high-fat and high-protein meal of adolescents with type 1 diabetes mellitus receiving intensive insulin therapy on postprandial blood glucose level: a randomized, crossover, breakfast study

In addition to carbohydrate count, this study aims to investigate the impact of the determination of bolus insulin doses by fat and protein counts on postprandial blood glucose level for adolescents having type 1 diabetes mellitus. The study was crossover and randomized; and all of participants were given standard breakfast (insulin dose according to carbohydrate/insulin ratio) for 1 day, and high-fat and high-protein breakfast for 2 days. The insulin dose for one of test meal was determined based on carbohydrate/insulin ratio. In the second application, in addition to carbohydrate/insulin ratios of the adolescents, 1 unit of insulin per what was added for each 200 kcal of energy provided from fat and protein of the meal. Postprandial blood glucose was recorded for 4 h using a continuous glucose monitoring system at intervals of 30 min. The mean blood glucose level between 0 and 240 min following consumption of different meals increased significantly in second application after 150th minute comparing with first application (p   0.05).However, the glycemic excursion of 30–0 min in third application was higher than the excursion in first and second applications while the glycemic excursion in first application between 150 and 120 min was higher than in third application (p < 0.05). These evidences demonstrated that high-fat and high-protein meal increases the requirement of insulin. Eventually, this study shows that there could be alternative algorithms to carbohydrate-based approach for the determination of the bolus insulin dose.