title: Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive.
abstract: OBJECTIVE
  To determine the separate and combined effects of high-protein (HP) and high-fat (HF) meals, with the same carbohydrate content, on postprandial glycemia in children using intensive insulin therapy (IIT).
  
  
  METHODS
  Thirty-three subjects aged 8-17 years were given 4 test breakfasts with the same carbohydrate amount but varying protein and fat quantities: low fat (LF)/low protein (LP), LF/HP, HF/LP, and HF/HP. LF and HF meals contained 4 g and 35 g fat. LP and HP meals contained 5 g and 40 g protein. An individually standardized insulin dose was given for each meal. Postprandial glycemia was assessed by 5-h continuous glucose monitoring.
  
  
  RESULTS
  Compared with the LF/LP meal, mean glucose excursions were greater from 180 min after the LF/HP meal (2.4 mmol/L [95% CI 1.1-3.7] vs. 0.5 mmol/L [-0.8 to 1.8]; P = 0.02) and from 210 min after the HF/LP meal (1.8 mmol/L [0.3-3.2] vs. -0.5 mmol/L [-1.9 to 0.8]; P = 0.01). The HF/HP meal resulted in higher glucose excursions from 180 min to 300 min (P < 0.04) compared with all other meals. There was a reduction in the risk of hypoglycemia after the HP meals (odds ratio 0.16 [95% CI 0.06-0.41]; P < 0.001).
  
  
  CONCLUSIONS
  Meals high in protein or fat increase glucose excursions in youth using IIT from 3 h to 5 h postmeal. Protein and fat have an additive impact on the delayed postprandial glycemic rise. Protein had a protective effect on the development of hypoglycemia.
authors.affiliation: Corresponding author: Bruce R. King, bruce.king@hnehealth.nsw.gov.au.
authors.forename: Carmel E M
authors.initials: CE
authors.lastname: Smart
authors.forename: Megan
authors.initials: M
authors.lastname: Evans
authors.forename: Susan M
authors.initials: SM
authors.lastname: O'Connell
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: Prudence E
authors.initials: PE
authors.lastname: Lopez
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Jones
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davis
authors.forename: Bruce R
authors.initials: BR
authors.lastname: King
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D004041:Dietary Fats / Q000494:pharmacology*; D004044:Dietary Proteins / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D004041:Dietary Fats; D004044:Dietary Proteins; D007328:Insulin