Influence of and optimal insulin therapy for a low-glycemic index meal in children with type 1 diabetes receiving intensive insulin therapy

Rochelle L Ryan, Bruce R King, Donald G Anderson, John R Attia, Clare E Collins, Carmel E Smart, Rochelle L Ryan, Bruce R King, Donald G Anderson, John R Attia, Clare E Collins, Carmel E Smart

Abstract

Objective: The purpose of this study was to quantify the effects of glycemic index on postprandial glucose excursion (PPGE) in children with type 1 diabetes receiving multiple daily injections and to determine optimal insulin therapy for a low-glycemic index meal.

Research design and methods: Twenty subjects consumed test breakfasts with equal macronutrient contents on 4 consecutive days; high-and low-glycemic index meals (glycemic index 84 vs. 48) were consumed with preprandial ultra-short-acting insulin, and the low-glycemic index meal was also consumed with preprandial regular insulin and postprandial ultra-short-acting insulin. Each child's insulin dose was standardized. Continuous glucose monitoring was used.

Results: The PPGE was significantly lower for the low-glycemic index meal compared with the high-glycemic index meal at 30-180 min (P < 0.02) when preprandial ultra-short-acting insulin was administered. The maximum difference occurred at 60 min (4.2 mmol/l, P < 0.0001). Regular insulin produced a 1.1 mmol/l higher PPGE at 30 min compared with ultra-short-acting insulin (P = 0.015) when the low-glycemic index meal was consumed. Postprandial ultra-short-acting insulin produced a higher PPGE at 30 and 60 min compared with preprandial administration when the low-glycemic index meal was consumed. The maximum difference was 2.5 mmol/l at 60 min (P < 0.0001).

Conclusions: Low-glycemic index meals produce a lower PPGE than high-glycemic index meals. Preprandial ultra-short-acting insulin is the optimal therapy for a low-glycemic index meal.

Figures

Figure 1
Figure 1
A: Low–versus high–glycemic index meal with preprandial ultra-short-acting insulin. ▪, low–glycemic index meal, preprandial ultra-short-acting insulin; ▴, high–glycemic index meal, preprandial ultra-short-acting insulin. Mean PPGEs of 20 patients after a low–glycemic index meal and high–glycemic index meal with preprandial ultra-short-acting insulin. Error bars represent 95% CI. The results are significantly different for 30–180 min (LSD, P < 0.02). B: Preprandial ultra-short-acting insulin versus preprandial regular insulin for a low–glycemic index meal. ▪, low–glycemic index meal, preprandial ultra-short-acting insulin; ▵, low–glycemic index meal, preprandial regular insulin. PPGEs after administration of ultra-short-acting insulin and regular insulin before a low–glycemic index meal. The results are significantly different at 30 min only (LSD, P < 0.02). C: Preprandial versus postprandial ultra-short-acting insulin for a low–glycemic index meal. ▪, low–glycemic index meal, preprandial ultra-short-acting insulin. •, low–glycemic index meal, postprandial ultra-short-acting insulin. PPGEs after administering preprandial and postprandial ultra-short-acting insulin with a low–glycemic index meal. The results were significantly different at 30 and 60 min (LSD, P < 0.02).

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