Postprandial Glucose Following High Glycemic Index Meals in Children and Adolescents with Type 1 Diabetes on Insulin Pump Therapy

Abstract Background Achieving postprandial normoglycemia is the most challenging part in the management of type 1 diabetes. Meal timing and meal composition affect glycemic outcomes. Nutritional properties of food, including protein, fat and glycemic index significantly impact postprandial glycemic excursions. Objective To assess efficacy of continuous subcutaneous insulin infusion (CSII) in optimizing postprandial glycemic excursions following the consumption of a high-glycemic index (high-GI) carbohydrate. Methods The current study is a non-blinded single arm randomized controlled trial including 24 participants with type1 diabetes regularly following up at the Pediatric and Adolescent Diabetes Unit (PADU), Pediatrics Hospital, Ain Shams University. All recruited children and adolescents were using the MiniMed® Paradigm Revel TM 523/723. The same high-GI breakfast with standardization of fat and protein content (cereal- cornflakes (contains 50 g carbohydrates, GI = 81±6) and skimmed milk (contains 0.5 g fats, 9 g carbohydrates, 6 g proteins) was given to all participants and prandial insulin dosage was individualized according to participants’ insulin-carb ratio. Insulin was delivered upfront as a standard bolus, given 15 minutes before consuming the test meal. Postprandial glycemic excursions were assessed using flash glucose monitoring system at 1, 2 and 3 hours post meal. Results The standard bolus didn’t control the early postprandial excursions, with highly significant postprandial excursions at 60 min and 120 min following consumption of the tested meal. The mean blood glucose level significantly increased from 101.79 ± 19.73 mg/dl at baseline to 167.50 ± 16.64 mg/dl at 60 min (P = 0.000). Similarly, at 120 min after consumption of the test meal, the mean glucose significantly increased to 183.83 ± 19.90 (P = 0.001) Conclusion High-GI carbohydrates modifies postprandial glycemic response causing early sharp glycemic rise, which was not controlled by the standard bolus of insulin delivery. Further studies are needed to define the optimal insulin delivery regimen required to optimize postprandial glycemia following the consumption of high-GI carbohydrates.