John Crowley


What do you think might change in diet and insulin dosage recommendations based on the new research published in Diabetes Care?

Patty Bonsignore


The research to which you are referring was done here at Joslin Diabetes Center in Boston, and is entitled “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.” The study found that, for people with type 1 diabetes, using just the carb amount in the meal to determine the meal-time bolus dose did not adequately control postprandial blood glucose levels, especially as the fat content in the meal increased. The higher the fat content, the higher the insulin requirements were for a given meal. To further complicate matters, the individual response to the fat content in the meal differed from one person to the next. The conclusion of this study is that carb counting alone is not sufficient to adequately control blood glucose levels in a type 1 population using insulin pumps and advanced carb counting. It will be interesting to see if future algorithms for calculating meal boluses will be able to incorporate the fat content of a given meal. For now calculating meal boluses, particularly in the presence of a lot of dietary fat, will remain largely a process of trial and error for the individual pump user. This study is the first step towards proving that fat has a bigger influence on blood glucose boluses than once thought and is important to consider in calculating the meal time bolus dose.

March 26, 2013 at 5:19 pm