For a high fat, high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with type 1 diabetes using multiple daily injections: A cross‐over trial. Issue 7 (2nd March 2021) - Smith, Tenele A.
ABSTRACT: Aim: To determine the glycaemic impact of an increased insulin dose, split insulin dose and regular insulin for a high fat, high protein breakfast in people with type 1 diabetes using multiple daily injections (≥4/day). Methods: In this cross‐over trial, participants received the same high fat, high protein breakfast (carbohydrate:30 g, fat:40 g, protein:50 g) for 4 days. Four different insulin strategies were randomly allocated and tested; 100% of the insulin‐to‐carbohydrate ratio (ICR) given in a single dose using aspart insulin (100Asp), 125% ICR given in a single dose using aspart (125Asp) or regular insulin (125Reg) and 125% ICR given in a split dose using aspart insulin (100:25Asp). Insulin was given 0.25 hr pre‐meal and for 100:25Asp, also 1 hr post‐meal. Postprandial sensor glucose was measured for 5 hr. Results: In all, 24 children and adults were participated. The 5‐hr incremental area under the curves for 100Asp, 125Asp, 125Reg and 100:25Asp were 620 mmol/L.min [95% CI: 451, 788], 341 mmol/L.min [169, 512], 675 mmol/L.min [504, 847] and 434 mmol/L.min [259, 608], respectively. The 5‐hr incremental area under the curve for 125Asp was significantly lower than for 100Asp ( p = 0.016) and for 125Reg ( p = 0.002). There was one episode of hypoglycaemia in 125Reg. Conclusions: For a high fat, high protein breakfast, giving 125% ICR preprandially, using aspart insulin significantly improved postprandial glycaemia without hypoglycaemia. There was no additional glycaemic benefit from giving insulin in a split dose (100:25%) or replacing aspart with regular insulin.