Additional Insulin After Certain Meals May Improve CV Risk in Type 1 Diabetes Patients

Patients with type 1 diabetes who receive an additional rapid-acting insulin bolus after consuming high-carbohydrate, high-fat meals can improve their cardiovascular (CV) risk, according to a recent study.

The study assessed 10 males with type 1 diabetes who were randomly assigned to a low-fat (LF) meal with normal bolus insulin, a high-fat (HF) meal with normal bolus insulin, or a high-fat meal with normal bolus insulin plus an additional 30% bolus (HFA), which was administered 3 hours after the meal.
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Each meal had the same amount of carbohydrates and protein. Counting carbohydrates determined the dose of bolus insulin given after meals.

The researchers analyzed participants’ blood samples 6 hours after each meal for triglycerides, non-esterified-fatty acids, apolipoprotein B48, glucagon, tumor necrosis factor-α, fibrinogen, human tissue factor activity, and plasminogen activator inhibitor-1. Interstitial glucose responses were assessed via continuous glucose monitoring.

Results showed that post-LF meal triglyceride levels stayed similar to baseline, whereas they were significantly increased during the 6 hours post-HF meal. After HFA, triglyceride levels were normalized by the additional insulin bolus, similarly to LF 3 to 6 hours post-meal.

The researchers linked HF to late postprandial elevations in tumor necrosis factor-α, but did not observe the same responses after LF and HFA. Additionally, they found that ibrinogen, plasminogen activator inhibitor-1, and tissue factor pathway levels were similar between each of the 3 groups.

“Additional bolus insulin 3 h following a high-carbohydrate high-fat meal prevents late rises in postprandial triglycerides and tumour necrosis factor alpha, thus improving cardiovascular risk profile,” the researchers concluded.

—Christina Vogt

Reference:

Campbell MD, Walker M, Ajjan RA, Birch KM, Gonzalez JT, West DJ. An additional bolus of rapid-acting insulin to normalise postprandial cardiovascular risk factors following a high-carbohydrate high-fat meal in patients with type 1 diabetes: a randomised controlled trial. Diabetes Vascular Dis Res. Published online March 21, 2017. https://doi.org/10.1177/1479164117698918.