title: Optimized Mealtime Insulin Dosing for Fat and Protein in Type 1 Diabetes: Application of a Model-Based Approach to Derive Insulin Doses for Open-Loop Diabetes Management.
abstract: To determine insulin dose adjustments required for coverage of high-fat, high-protein (HFHP) meals in type 1 diabetes (T1D).
  
  
  
  Ten adults with T1D received low-fat, low-protein (LFLP) and HFHP meals with identical carbohydrate content, covered with identical insulin doses. On subsequent occasions, subjects repeated the HFHP meal with an adaptive model-predictive insulin bolus until target postprandial glycemic control was achieved.
  
  
  
  With the same insulin dose, the HFHP increased the glucose incremental area under the curve over twofold (13,320 ± 2,960 vs. 27,092 ± 1,709 mg/dL ⋅ min; P = 0.0013). To achieve target glucose control following the HFHP, 65% more insulin was required (range 17%-124%) with a 30%/70% split over 2.4 h.
  
  
  
  This study demonstrates that insulin dose calculations need to consider meal composition in addition to carbohydrate content and provides the foundation for new insulin-dosing algorithms to cover meals of varying macronutrient composition.
authors.affiliation: Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, New South Wales, Australia Joslin Diabetes Center, Boston, MA.
authors.forename: Kirstine J
authors.initials: KJ
authors.lastname: Bell
authors.affiliation: Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA.
authors.forename: Elena
authors.initials: E
authors.lastname: Toschi
authors.affiliation: Harvard Medical School, Boston, MA Boston Children's Hospital, Boston, MA.
authors.forename: Garry M
authors.initials: GM
authors.lastname: Steil
authors.affiliation: Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA howard.wolpert@joslin.harvard.edu.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Wolpert
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D004305:Dose-Response Relationship, Drug; D005260:Female; D038321:Glycemic Index; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D062407:Meals; D008875:Middle Aged; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D007004:Hypoglycemic Agents; D007328:Insulin