title: Antecedent caloric intake and glucose excursion following a subsequent meal in Type 1 diabetes.
abstract: BACKGROUND
  In the present study, we tested the hypothesis that calories consumed at a prior meal (lunch) may impair glycemic control after a subsequent meal (supper) even if the pre-supper glucose did not differ regardless of the size of the lunch meal.
  
  
  METHODS
  Nine subjects with Type 1 diabetes using continuous subcutaneous (s.c.) insulin infusion (CSII) therapy were studied on two separate days. Lunch (1200 h) was randomly assigned as 25% or 50% of the usual daily intake on alternate study days. The CSII was stopped at 1000 h on the day of the study and glucose was controlled until supper by adjusting the rate of intravenous (i.v.) insulin based on glucose measurements every 15 min. The CSII was restarted 1 h before supper and i.v. insulin discontinued 15 min before the first bite of supper. An identical supper meal and pre-supper s.c. bolus of short-acting insulin were administered on both visits.
  
  
  RESULTS
  Pre-supper glycemia was nearly identical on each of the two study days. However, the post-supper glucose area under the curve was 27.5% greater on the day of the antecedent large lunch compared with the small lunch (P = 0.0039).
  
  
  CONCLUSIONS
  For optimal postprandial glucose control, people with Type 1 diabetes may need to consider not only anticipated meal calories, but also prior food intake, a practice not commonly recommended based on currently used insulin dosing algorithms.
authors.affiliation: Division of Pediatric, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Rinku
authors.initials: R
authors.lastname: Mehra
authors.forename: Ramesh
authors.initials: R
authors.lastname: Raman
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Bayless
authors.forename: William I
authors.initials: WI
authors.lastname: Sivitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D003927:Diet, Diabetic; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin