Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Diabetes Reports
Published in: Current Diabetes Reports 9/2015

Open Access 01-09-2015 | Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (E Mayer-Davis and C Shay, Section Editors)

The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management

Authors: Megan Paterson, Kirstine J. Bell, Susan M. O’Connell, Carmel E. Smart, Amir Shafat, Bruce King

Published in: Current Diabetes Reports | Issue 9/2015

Login to get access

Abstract

A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies.
Literature
1.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRef
2.
Hoey H, Aanstoot HJ, Chiarelli F, et al. Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes. Diabetes Care. 2001;24(11):1923–8.CrossRefPubMed
3.
DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ. 2002;325(7367):746.PubMedCentralCrossRef
4.
Lowe J, Linjawi S, Mensch M, et al. Flexible eating and flexible insulin dosing in patients with diabetes: results of an intensive self-management course. Diabetes Res Clin Pract. 2008;80(3):439–43.CrossRefPubMed
5.
Laurenzi A, Bolla AM, Panigoni G, et al. Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR). Diabetes Care. 2011;34(4):823–7.PubMedCentralCrossRefPubMed
6.
McIntyre HD, Knight BA, Harvey DM, et al. Dose adjustment for normal eating (DAFNE)—an audit of outcomes in Australia. Med J Aust. 2010;192(11):637–40.PubMed
7.
Samann A, Muhlhauser I, Bender R, et al. Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: a prospective implementation study. Diabetologia. 2005;48(10):1965–70.CrossRefPubMed
8.
Scavone G, Manto A, Pitocco D, et al. Effect of carbohydrate counting and medical nutritional therapy on glycaemic control in type 1 diabetic subjects: a pilot study. Diabet Med. 2010;27(4):477–9.CrossRefPubMed
9.
Choleau C, Aubert C, Cahane M, et al. High day-to-day glucose variability: a frequent phenomenon in children and adolescents with type 1 diabetes attending summer camp. Diabetes Metab. 2008;34(1):46–51.CrossRefPubMed
10.
Cameron FJ, de Beaufort C, Aanstoot HJ, et al. Lessons from the Hvidoere International Study Group on childhood diabetes: be dogmatic about outcome and flexible in approach. Pediatr Diabetes. 2013;14(7):473–80.CrossRefPubMed
11.
Mortensen HB, Robertson KJ, Aanstoot HJ, et al. Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Hvidore Study Group on childhood diabetes. Diabet Med. 1998;15(9):752–9.CrossRefPubMed
12.
Bell KJ, Barclay AW, Petocz P, et al. Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2014;2(2):133–40.CrossRefPubMed
13.
Borg R, Kuenen JC, Carstensen B, et al. Associations between features of glucose exposure and A1C: the A1C-derived average glucose (ADAG) study. Diabetes. 2010;59(7):1585–90.PubMedCentralCrossRefPubMed
14.
Borg R, Kuenen JC, Carstensen B, et al. HbA(1)(c) and mean blood glucose show stronger associations with cardiovascular disease risk factors than do postprandial glycaemia or glucose variability in persons with diabetes: the A1C-derived average glucose (ADAG) study. Diabetologia. 2011;54(1):69–72.PubMedCentralCrossRefPubMed
15.
Smart C. Counting fat and protein: a dietitian’s perspective. Diabetes Care Child Young People. 2013;2(2):71–3.
16.
Pankowska E, Blazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther. 2012;14(1):16–22.CrossRefPubMed
17.
Peters AL, Davidson MB. Protein and fat effects on glucose responses and insulin requirements in subjects with insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993;58(4):555–60.PubMed
18.••
Smart CE, Evans M, O’Connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care. 2013;36(12):3897–902. This study suggests that the insulin requirements of CHO, fat and protein could be calculated independently and be added together.
19.••
Wolpert HA, Atakov-Castillo A, Smith SA, et al. 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. Diabetes Care. 2013;36(4):810–6. This research attempts to quantify the impact of fat on insulin requirements and gives the potential to develop recommendations for insulin strategies.
20.••
Kordonouri O, Hartmann R, Remus K, et al. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatr Diabetes. 2012;13(7):540–4. This study confirmed that additional insulin for fat and protein improved glycaemic control but highlighted a high rate of hypoglycaemia suggesting refinement is required.
21.
Slama G, Klein J, Delage A, et al. Correlation between the nature and amount of carbohydrate in meal intake and insulin delivery by the artificial pancreas in 24 insulin-dependent diabetics. Diabetes. 1981;30:101–5.CrossRefPubMed
22.
Service FJ, Rizza RA, Hall L, et al. Prandial insulin requirements in insulin-dependent diabetics: effects of size, time of day and sequence of meals. J Clin Endocrinol Metab. 1983;57:931–6.CrossRefPubMed
23.
Halfon P, Belkhadir J, Slama G. Correlation between amount of carbohydrate in mixed meals and insulin delivery by artificial pancreas in seven IDDM subjects. Diabetes Care. 1989;12:427–9.CrossRefPubMed
24.
Vlachokosta FV, Piper CM, Gleason R, et al. Dietary carbohydrate, a Big Mac, and insulin requirements in type I diabetes. Diabetes Care. 1988;11(4):330–6.CrossRefPubMed
25.
Schrezenmeir J, Tato F, Tato S, et al. Comparison of glycemic response and insulin requirements after mixed meals of equal carbohydrate content in healthy, type-1, and type-2 diabetic man. Klin Wochenschr. 1989;67(19):985–94.CrossRefPubMed
26.
Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37 Suppl 1:S120–43.CrossRefPubMed
27.
Smart CE, Annan F, Bruno LP, et al. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2014;15 Suppl 20:135–53.CrossRefPubMed
28.
Freckmann G, Hagenlocher S, Baumstark A, et al. Continuous glucose profiles in healthy subjects under everyday life conditions and after different meals. J Diabetes Sci Technol. 2007;1(5):695–703.PubMedCentralCrossRefPubMed
29.
Desjardins K, Brazeau AS, Strychar I, et al. Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes. Diabetes Res Clin Pract. 2014;106(3):420–7.CrossRefPubMed
30.
Berg JM, Tymoczko J, Stryer L. Biochemistry. 7th ed. Basinstoke: W. H. Freeman; 2012.
31.
Turner N, Cooney GJ, Kraegen EW, et al. Fatty acid metabolism, energy expenditure and insulin resistance in muscle. J Endocrinol. 2014;220(2):T61–79.CrossRefPubMed
32.
Grygiel-Gorniak B. Peroxisome proliferator-activated receptors and their ligands: nutritional and clinical implications—a review. Nutr J. 2014;13:17.PubMedCentralCrossRefPubMed
33.
Radulescu A, Gannon MC, Nuttall FQ. The effect on glucagon, glucagon-like peptide-1, total and acyl-ghrelin of dietary fats ingested with and without potato. J Clin Endocrinol Metab. 2010;95(7):3385–91.PubMedCentralCrossRefPubMed
34.
Lodefalk M, Carlsson-Skwirut C, Holst JJ, et al. Effects of fat supplementation on postprandial GIP, GLP-1, ghrelin and IGFBP-1 levels: a pilot study on adolescents with type 1 diabetes. Horm Res Paediatr. 2010;73(5):355–62.CrossRefPubMed
35.
Karhunen LJ, Juvonen KR, Huotari A, et al. Effect of protein, fat, carbohydrate and fibre on gastrointestinal peptide release in humans. Regul Pept. 2008;149(1–3):70–8.CrossRefPubMed
36.
Ferraris RP, Diamond J. Regulation of intestinal sugar transport. Physiol Rev. 1997;77(1):257–302.PubMed
37.
Horowitz M, Edelbroek MA, Wishart JM, et al. Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia. 1993;36(9):857–62.CrossRefPubMed
38.
Carbonnel F, Lemann M, Rambaud JC, et al. Effect of the energy density of a solid-liquid meal on gastric emptying and satiety. Am J Clin Nutr. 1994;60(3):307–11.PubMed
39.
Welch IM, Bruce C, Hill SE, et al. Duodenal and ileal lipid suppresses postprandial blood glucose and insulin responses in man: possible implications for the dietary management of diabetes mellitus. Clin Sci (Lond). 1987;72(2):209–16.CrossRef
40.
Clegg M, Pratt M, Markey O, et al. Addition of different fats to a carbohydrate food: Impact on gastric emptying, glycaemic and satiety responses and comparison with in vitro digestion. Food Res Int. 2012;48(1):91–7.CrossRef
41.
Clegg M, Shafat A. Energy and macronutrient composition of breakfast affect gastric emptying of lunch and subsequent food intake, satiety and satiation. Appetite. 2010;54(3):517–23.CrossRefPubMed
42.
Clegg M, Shafat A. Conference on “Multidisciplinary Approaches to Nutritional Problems”. Postgraduate Symposium. The role of fat in gastric emptying and satiety: acute and chronic effects. Proc Nutr Soc. 2009;68(1):89–97.CrossRefPubMed
43.
Khan MA, Gannon MC, Nuttall FQ. Glucose appearance rate following protein ingestion in normal subjects. J Am Coll Nutr. 1992;11(6):701–6.CrossRefPubMed
44.
van Loon LJ, Saris WH, Verhagen H, et al. Plasma insulin responses after ingestion of different amino acid or protein mixtures with carbohydrate. Am J Clin Nutr. 2000;72(1):96–105.PubMed
45.
Winiger G, Keller U, Laager R, et al. Protein content of the evening meal and nocturnal plasma glucose regulation in type-I diabetic subjects. Horm Res. 1995;44(3):101–4.CrossRefPubMed
46.
Krezowski PA, Nuttall FQ, Gannon MC, et al. The effect of protein ingestion on the metabolic response to oral glucose in normal individuals. Am J Clin Nutr. 1986;44(6):847–56.PubMed
47.
Nordt TK, Besenthal I, Eggstein M, et al. Influence of breakfasts with different nutrient contents on glucose, C peptide, insulin, glucagon, triglycerides, and GIP in non-insulin-dependent diabetics. Am J Clin Nutr. 1991;53(1):155–60.PubMed
48.
Garcia-Lopez JM, Gonzalez-Rodriguez M, Pazos-Couselo M, et al. Should the amounts of fat and protein be taken into consideration to calculate the lunch prandial insulin bolus? Results from a randomized crossover trial. Diabetes Technol Ther. 2013;15(2):166–71.PubMedCentralCrossRefPubMed
49.
Paterson MA, Smart CE, McElduff P, et al. Influence of pure protein on postprandial blood glucose levels in individuals with type 1 diabetes mellitus (abstract). Diabetes. 2014;63(S1):A15.
50.
Wilson D, Chase HP, Kollman C, et al. Low-fat vs. high-fat bedtime snacks in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2008;9(4 Pt 1):320–5.CrossRefPubMed
51.
Brown RJ, Sinaii N, Rother KI. Too much glucagon, too little insulin: time course of pancreatic islet dysfunction in new-onset type 1 diabetes. Diabetes Care. 2008;31(7):1403–4.PubMedCentralCrossRefPubMed
52.
Slag MF, Ahmad M, Gannon MC, et al. Meal stimulation of cortisol secretion: a protein induced effect. Metabolism. 1981;30(11):1104–8.CrossRefPubMed
53.
van Vught AJ, Nieuwenhuizen AG, Brummer RJ, et al. Somatotropic responses to soy protein alone and as part of a meal. Eur J Endocrinol. 2008;159(1):15–8.CrossRefPubMed
54.
Koliaki C, Kokkinos A, Tentolouris N et al. The effect of ingested macronutrients on postprandial ghrelin response: a critical review of existing literature data. Int J Pept. 2010;2010.
55.
56.
Felig P, Wahren J, Sherwin R, et al. Amino acid and protein metabolism in diabetes mellitus. Arch Intern Med. 1977;137(4):507–13.CrossRefPubMed
57.
Linn T, Geyer R, Prassek S, et al. Effect of dietary protein intake on insulin secretion and glucose metabolism in insulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1996;81(11):3938–43.PubMed
58.
Wahren J, Felig P, Hagenfeldt L. Effect of protein ingestion on splanchnic and leg metabolism in normal man and in patients with diabetes mellitus. J Clin Invest. 1976;57(4):987–99.PubMedCentralCrossRefPubMed
59.
Pankowska E, Blazik M. Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. J Diabetes Sci Technol. 2010;4(3):571–6.PubMedCentralCrossRefPubMed
60.
Neu A, Behret F, Braun R et al. Higher glucose concentrations following protein- and fat-rich meals—the Tuebingen Grill Study: a pilot study in adolescents with type 1 diabetes. Pediatr Diabetes. 2014.
61.
Ryan RL, King BR, Anderson DG, et al. Influence of and optimal insulin therapy for a low-glycemic index meal in children with type 1 diabetes receiving intensive insulin therapy. Diabetes Care. 2008;31(8):1485–90.PubMedCentralCrossRefPubMed
62.
Scaramuzza AE, Iafusco D, Santoro L, et al. Timing of bolus in children with type 1 diabetes using continuous subcutaneous insulin infusion (TiBoDi Study). Diabetes Technol Ther. 2010;12(2):149–52.CrossRefPubMed
63.
Jovanovic L, Giammattei J, Acquistapace M, et al. Efficacy comparison between preprandial and postprandial insulin aspart administration with dose adjustment for unpredictable meal size. Clin Ther. 2004;26(9):1492–7.CrossRefPubMed
64.
Cobry E, McFann K, Messer L, et al. Timing of meal insulin boluses to achieve optimal postprandial glycemic control in patients with type 1 diabetes. Diabetes Technol Ther. 2010;12(3):173–7.CrossRefPubMed
65.
Chase HP, Saib SZ, MacKenzie T, et al. Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with type 1 diabetes. Diabet Med. 2002;19(4):317–21.CrossRefPubMed
66.
Lopez P, Smart C, Morbey C, et al. Extended insulin boluses cannot control postprandial glycemia as well as a standard bolus in children and adults using insulin pump therapy. BMJ Open Diabetes Res Care. 2014;2(1), e000050.PubMedCentralCrossRefPubMed
67.
Bao J, Gilbertson HR, Gray R, et al. Improving the estimation of mealtime insulin dose in adults with type 1 diabetes: the Normal Insulin Demand for Dose Adjustment (NIDDA) study. Diabetes Care. 2011;34(10):2146–51.PubMedCentralCrossRefPubMed
68.
Bell KJ, Gray R, Munns D, et al. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr. 2014;68(9):1055–9.CrossRefPubMed
69.
Bell K, Toschi, E, Wolpert, H, Steil, G. Use of model predicted bolus estimation (mpb) to optimize insulin dosing strategies covering high fat meals. 8th International Conference on Advanced Technologies and Treatments for Diabetes; Paris, France 2015.
70.
Lindholm-Olinder ARJ, Smide B, Kernell A. Post-prandial glucose levels following three methods of insulin bolusing: a study in adolescent girls and in comparison with girls without diabetes. Pract Diabetes Int. 2009;26(3):110–5.CrossRef
71.
Jones SM, Quarry JL, Caldwell-McMillan M, et al. Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. Diabetes Technol Ther. 2005;7(2):233–40.CrossRefPubMed
Metadata
Title
The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management
Authors
Megan Paterson
Kirstine J. Bell
Susan M. O’Connell
Carmel E. Smart
Amir Shafat
Bruce King
Publication date
01-09-2015
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 9/2015
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-015-0630-5

Other articles of this Issue 9/2015

Current Diabetes Reports 9/2015 Go to the issue

Microvascular Complications—Nephropathy (T Isakova, Section Editor)

Impact of Lifestyle Modification on Diabetic Kidney Disease

Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (E Mayer-Davis and C Shay, Section Editors)

Infant Feeding and Timing of Complementary Foods in the Development of Type 1 Diabetes

Microvascular Complications—Nephropathy (T Isakova, Section Editor)

Update on Estimation of Kidney Function in Diabetic Kidney Disease

Pathogenesis of Type 2 Diabetes and Insulin Resistance (RM Watanabe, Section Editor)

Transcriptional Regulation of the Pancreatic Islet: Implications for Islet Function

Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (E Mayer-Davis and C Shay, Section Editors)

Salt Restriction in Diabetes

Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston, Section Editor)

National Strategies to Decrease the Burden of Diabetes and Its Complications
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits