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首页> 外文期刊>Diabetes care >Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management
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Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management

机译：1型糖尿病患者的膳食脂肪急剧增加葡萄糖浓度和胰岛素要求：对碳水化合物的推注剂量计算和强化糖尿病管理的影响

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OBJECTIVE-Current guidelines for intensive treatment of type 1 diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting. There is strong evidence that free fatty acids impair insulin sensitivity. We hypothesized that patients with type 1 diabetes would require more insulin coverage for higher-fat meals than lower-fat meals with identical carbohydrate content. RESEARCH DESIGN AND METHODS-We used a crossover design comparing two 18-h periods of closed-loop glucose control after high-fat (HF) dinner compared with low-fat (LF) dinner. Each dinner had identical carbohydrate and protein content, but different fat content (60 vs. 10 g). RESULTS-Seven patients with type 1 diabetes (age, 55 ?? 12 years; A1C 7.2 ?? 0.8%) successfully completed the protocol. HF dinner required more insulin than LF dinner (12.6 ?? 1.9 units vs. 9.0 ?? 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia (area under the curve 120 mg/dL = 16,967 ?? 2,778 vs. 8,350 ?? 1,907 mg/dLzmin; P 0001). Carbohydrate-to-insulin ratio forHF dinnerwas significantly lower (9??2 vs. 13??3 g/unit; P = 0.01). There were marked interindividual differences in the effect of dietary fat on insulin requirements (percent increase significantly correlated with daily insulin requirement; R2 = 0.64; P = 0.03). CONCLUSIONS-This evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes. ? 2013 by the American Diabetes Association.
机译：1型糖尿病型糖尿病型密集治疗的客串目前指南基于碳水化合物计数的膳食胰岛素推注计算。有很强的证据表明游离脂肪酸损害胰岛素敏感性。我们假设1型糖尿病的患者需要比具有相同碳水化合物含量的低脂肪膳食更高脂肪餐的胰岛素覆盖。研究设计和方法 - 我们使用了与低脂肪（LF）晚餐相比的高脂肪（HF）晚餐后的两次闭环葡萄糖控制的交叉设计。每种晚餐具有相同的碳水化合物和蛋白质含量，但不同的脂肪含量（60 vs.10g）。结果-7型糖尿病患者（年龄，55〜12岁; A1C 7.2 ?? 0.8％）成功完成了“议定书”。 HF晚餐需要比LF晚餐更多的胰岛素（12.6 ?? 1.9单位与9.0〜3个单位; P = 0.01），并且尽管额外的胰岛素，导致更多的高血糖（曲线下的面积<120mg / dl = 16,967？ ？2,778与8,350 ?? 1,907 mg / dlzmin; p＆ 0001）。碳水化合物至胰岛素比率对耐药性显着降低（9 ?? 2与13？3 G /单位; P = 0.01）。膳食脂肪对胰岛素脂肪的影响（百分比与日常胰岛素要求显着相关的百分比）显着差异; R2 = 0.64; p = 0.03）。结论 - 膳食脂肪增加葡萄糖水平和胰岛素要求的证据突出了当前碳水化合物的基于碳水化合物的血管剂量计算的局限性。这些发现指出了对更高脂肪膳食的替代胰岛素剂量给药算法的需要，并表明膳食脂肪摄入是患有1型糖尿病患者血糖控制的重要营养考虑因素。还是2013年由美国糖尿病协会。

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  • 来源
    《Diabetes care》 |2013年第4期|共7页
  • 作者

    WolpertH.A.; Atakov-CastilloA.; SmithS.A.; SteilG.M.;

  • 作者单位

    Joslin Diabetes Center Boston MA United States Harvard Medical School Boston MA United States;

    Joslin Diabetes Center Boston MA United States;

    Joslin Diabetes Center Boston MA United States;

    Harvard Medical School Boston MA United States Children's Hospital Boston MA United States;

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  • 正文语种 eng
  • 中图分类 内分泌腺疾病及代谢病;
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