The influence of and optimal insulin therapy for a low glycemic index meal in children with type one diabetes on intensive insulin therapy

Abstract

Objective: To quantify the effects of glycemic index (GI) on the postprandial blood glucose excursion (PPGE) in children with type 1 diabetes on multiple daily injections (MDI). To determine optimal insulin therapy for a low GI meal.

Research design and methods: 20 subjects consumed test breakfasts, with equal macronutrient contents on four consecutive days; high and low GI meals (GI: 84 vs. 48) were consumed with preprandial ultra short acting insulin, and the low GI meal was also consumed with preprandial regular insulin and postprandial ultra short acting insulin. Each child's insulin dose was standardized. Continuous glucose monitoring was used.

Results: The PPGE was significantly lower for the low GI meal compared to the high GI meal at 30-180 minutes (p<0.02) when preprandial ultra short acting insulin was administered. The maximum difference occurred at 60 minutes (4.2 mmol/l p<0.0001).

Results: Regular insulin produced a 1.1 mmol/l higher PPGE at 30 minutes compared to ultra short acting insulin (p=0.015) when the low GI meal was consumed.

Results: Postprandial ultra short acting insulin produced a higher PPGE at 30 and 60 minutes compared to preprandial administration when the low GI meal was consumed. The maximum difference was 2.5 mmol/l at 60minutes (P<0.0001).

Conclusions: Low GI meals produce a lower PPGE compared to high GI meals. Preprandial ultra short acting insulin is the optimal therapy for a low GI meal.