Trial to simplify insulin dose for diabetes

Jun 19 2019

Dr Carmel Smart

Those with diabetes have been carb counting to calculate meal insulin for a long time, but what about the impact of fat and protein on blood glucose levels?

HNE Health researchers have found fat and protein eaten in meals also impacts blood glucose levels, and have now determined the amount of insulin needed to balance this increase.

A randomised control trial is underway, which sees patients with type 1 diabetes or their families enter food intake into an App known as OptimAAPP. The insulin dosage is then provided based on an algorithm built into the App.

The work is being led by Clinical Research Fellow and Senior Paediatric Dietitian, Dr Carmel Smart, as part of a Clinical Fellowship. Dr Smart conducts her research in collaboration with the University of Newcastle and the Hunter Medical Research Institute (HMRI)*.

The aim of the trial is to determine if insulin dosing for fat and protein in addition to carbohydrate improves blood glucose levels, and to find a simple way for families and health professionals to dose for this accurately.

“The App was developed in conjunction with engineers at the University of Newcastle, and the plan is to roll it out nationally and internationally.

“This will enable the translation of Hunter New England Health’s studies into clinical practice, by providing a tool to assist complicated calculations for insulin dosing,” Dr Smart said.

Five-year-old Elaine Le Roux has been using the app for a few months. Her mother Cecile said the app has been very helpful in managing her daughter’s type 1 diabetes.

“It’s like a database which we put the nutrition information of all of the food Elaine regularly eats into. It means we don’t have to remember how much fat, protein or carbohydrate is in each food or have the package in front of us,” Cecile said.

“The App then tells me how much insulin is needed with that meal.

“We have actually introduced more meat into our diets since we started using the App, as we’ve seen the benefit of protein on Elaine’s glucose levels.”

The study follows previous HNE-led research which looked at how accurately patients needed to count carbohydrate eaten at a meal to calculate the correct insulin dose. This work became a benchmark for international standards, and is a key component of the success of the John

 Hunter Children’s Hospital program. However diabetes team members and patients were still challenged by highs and lows in patients’ blood glucose levels.

Dr Smart says the work is not just about preventing long-term health complications but also making food choices easier and less stressful for those living with type 1 diabetes.

“In the Hunter region more than 350 toddlers, children and adolescents have type 1 diabetes, which can leads to significant sickness if not well managed, as well as a large burden for families and the health system,” Dr Smart said. “People may avoid certain food groups altogether as a way of controlling blood glucose levels and this is unnecessary and can be unhealthy.”

* HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.