Endocrine Abstracts

Optimising postprandial glycaemia remains one of the most challenging aspects of diabetes management. The addition of fat and protein to a meal containing carbohydrate increases the post prandial glycaemic excursion but current meal insulin dose algorithms are generally based on the carbohydrate content of the meal and until

recently have not included the influence of fat and protein on postprandial glucose excursions. Traditionally several factors are used to account for the effects of fat on the glycaemic response to mixed meals. These include (i.) delay in gastric emptying, (ii.) insulin resistance in muscle and (iii.) increased hepatic gluconeogenesis. Other researchers have shown that for carbohydrate containing meals, fat causes delayed gastric emptying which decreases the glucose levels in the 2 hours after meal ingestion.

Dosing for protein and fat in children and adolescents has been challenging, with high rates of hypoglycaemia noted in various studies using specific insulin dosing methods. Even with new technologies such as the hybrid closed loop, prediction of glycaemic response to high fat meals can be challenging. Current guidelines recommend that fat and protein should be considered when the meal insulin dose is calculated but until recently it was unknown if fat had a threshold or dose dependent impact.

This presentation will discuss various factors involved in the glycaemic impact of meals with high fat, and will explore the recent studies and recommendations on dosing for both high protein and fat.

The results of the first study to look at the impact of fat alone on postprandial blood glucose levels will be presented and the potential implications of the results for insulin dosing in high fat meals discussed.