Optimized mealtime insulin dosing for fat and protein in type 1 diabetes: Application of a model-based approach to derive insulin doses for open-loop diabetes management

Abstract

OBJECTIVE To determine insulin dose adjustments required for coverage of high-fat, highprotein (HFHP) meals in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive modelpredictive insulin bolus until target postprandial glycemic control was achieved. RESULTS With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320±2,960 vs. 27,092± 1,709 mg/dL min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%-124%) with a 30%/70% split over 2.4 h. CONCLUSIONS This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.