Trending High Fat and Protein Diets May Need Insulin Dose Adjustments  

Do meals with high fat or high protein content allow for the prescribed insulin dose to balance glucose levels in a patient with type 1 diabetes? 

In recent years, high-fat diets have increased in popularity, creating the need for individuals with type 1 diabetes to adjust for dietary fat and protein during mealtime. Recently, researchers designed a series of randomized trials in people living with type 1 diabetes. In these trials, the analysis showed that the consumption of fat and protein in meals with carbohydrates could reduce the early postprandial rise in the one to a two-hour range of the postprandial period. Fat and protein also contribute to postprandial hyperglycemia in the late postprandial period, which falls between the third and fifth hour. Continuous glucose monitoring has been used in clinical practice to pinpoint the effects various meal types have on human glucose levels. The monitoring strategy attests that mealtime insulin dosing methods that are based solely on carbohydrate counting have disadvantages. Most can agree there is an obvious need for a safe, evidence-based, and practical strategy to aid in the adjustment of insulin for people with type 1 diabetes who consume high-fat and high-protein meals. In this study, the author addresses the compelling clinical question of optimal insulin modifications for meals that contain different amounts of dietary fat. This question is pressing due to postprandial hyperglycemia being classified as a risk factor; postprandial hyperglycemia is a risk component for the development of long-term complications of diabetes.  

In this randomized subject trial study, the researchers analyze the requirements for incremental insulin doses of fat. This study was a continuance of the previous study the examiners performed, including thirty-three subjects. The participants ranged from eight to seventeen years of age. The patients were given four test breakfasts with the same amount of carbohydrate but different fat and protein quantities. Low fat and high-fat meals contained 4 grams and 35 grams of fat. Low protein and high protein meals included 5 grams and 40 grams of protein. For each meal, a standardized insulin dose was given to each participant. Postprandial glycemia was assessed and monitored over 5 hours. 

For this particular study, the main result was that the mean for additional insulin required for a meal increased. The mean increased from 6% for both an extra 20 grams and 40 grams of fat to 21% for an extra 60 grams of fat. The variation involving the participants was high in earlier studies, with half of the individuals that generally consume 40 grams of added fat in each mean requiring their usual dose. Even though the interindividual variations highlight the challenges in clinical translation and recommendations, the predictive control algorithm shows how the postprandial area under the glucose curve following high-fat meals continues to improve without an increase in hypoglycemia.  

Not many studies have specified the span and split of the combination bolus. Some of the new data addressed in this study present the best time that the combination bolus will increase with fat amount is from 73 min of 20 grams of fat (75%/25%) to 105 min for 60 grams of fat (50%/50%). These results provide abetment for recommendations that a more significant proportion of the total insulin dose is needed to be given to the patient for a shorter period; about fifty percent or more of the total insulin dose should be given over less than 2 hours. Different types of food will require different methods. The implementation of multiple approaches for meals of varying macronutrient compositions will be necessary for dosing algorithms.  

According to this study, optimal postprandial glycemia is dependent on the composition of the entire meal. The results presented in this research have some indications in the clinical practice setting. It is a fact that insulin is necessary for dietary fat, and the dose adjustment of insulin is predicated on the sensitivity of individual and quantity of fat. It recommended adjusting insulin according to the amount of fat that is being consumed. This method requires tailoring to the individual which calls for a lot of consistency from the patient and physician. As time and research progress, meal algorithms must improve in performance regarding each person’s glycemic response. Research is yet required to determine the practice of routine protein and fat dosing into the clinical setting.   

Practice Pearls: 

• Mealtime insulin dosing methods that are based solely on carbohydrate counting have disadvantages. 
• Postprandial glycemia is dependent on the composition of the entire meal. 

• It is a fact that insulin is necessary for dietary fat, and the dose adjustment of insulin is predicated on the sensitivity of individual and quantity of fat. 

Smart CEM, King BR, Lopez PE. Insulin Dosing for Fat and Protein: Is it Time?. Diabetes Care. 2020;43(1):13–15. doi:10.2337/dci19-0039 

Smart CE, Evans M, O’Connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 2013;36:3897–3902 

Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy 

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