A common challenge for people with type 1 diabetes (T1D) is controlling significant elevations of blood glucose following meals [1]. This is of concern as postprandial hyperglycaemia has been identified as an important risk factor in the development of long-term complications of T1D including cardiovascular disease [2].

Current clinical practice in insulin pump therapy focuses on carbohydrate counting to determine meal-time insulin requirements. However, research from our team [3, 4] and others [5-7] indicates that the consumption of meals high in fat and/or protein results in delayed hyperglycaemia. In collaboration with Princess Margaret Hospital, Perth we demonstrated that the addition of fat and protein to a meal containing a consistent carbohydrate resulted in postprandial hyperglycaemia in children and adolescents with T1D [3, 4] (See Figure 1). Furthermore, when the fat and protein were consumed together there was a late additive effect between 3 and 5 hours after the meal [3]. More recently, our group has published data examining the impact of pure protein independent of carbohydrate and fat on postprandial blood glucose levels in TID [8]. The importance of research into the impact of other macronutrients on postprandial glycaemia was highlighted in the current editorial of Diabetic Medicine (May 2016), with the editor acknowledging the complexity of calculating additional insulin doses for protein and fat-rich meals [9]. While these findings have demonstrated the need for additional insulin for a high protein, high fat meal, our research has confirmed that current insulin dosing methods commonly used in Europe for high fat, high protein meals result in an unacceptably high risk of postprandial hypoglycaemia [10]. Therefore research is needed in order to determine a safe and effective insulin dosing algorithm for meals high in fat and protein permitting the translation of this data into clinical practice. This study will provide information on the dose of insulin required to cover meals high in fat and protein. The results will have direct clinical translation, informing clinicians of a simple, effective way to calculate and deliver insulin for the fat and protein content of a meal. This will help to optimise glycaemic control and improve long term outcomes for all people living with type 1 diabetes.


Dr Carmel Smart, Associate Professor Bruce King

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