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Isolated protein consumption increases postprandial glucose in type 1 diabetes

Discussion in 'General Discussion' started by Michelle'sMom, Jan 7, 2016.

  1. Michelle'sMom

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    http://www.healio.com/endocrinology...eases-postprandial-glucose-in-type-1-diabetes


    Endocrine Today
    In the Journals
    Isolated protein consumption increases postprandial glucose in type 1 diabetes
    Paterson MA, et al. Diabet Med. 2016;doi:10.1111/dme.13011.
    January 6, 2016

    Children and adults with type 1 diabetes who consumed more than 75 g liquid protein alone experienced a late and sustained rise in postprandial glucose compared with those who drank water, according to research in Diabetic Medicine.

    Megan A. Paterson, of the Hunter Medical Research Institute and the School of Medicine and Public Health at the University of Newcastle, Australia, and colleagues analyzed data from 27 children and adults with type 1 diabetes on either insulin pump therapy or multiple daily injections, with HbA1c of 8.5% or less and a healthy BMI (16 girls and women; mean age, 22 years; mean diabetes duration, 7.8 years; mean BMI, 21 kg/m²; 14 using pump therapy). Participants consumed five premeasured test drinks of whey isolate protein and water (12.5 g, 25 g, 50 g, 75 g and 100 g), plus one control drink of water, as well as two 150 mL glucose drinks (10 g and 20 g) without insulin. Researchers assigned beverages in a randomized order over 8 days and 4 hours after consuming an evening meal standardized for the amount and type of carbohydrate, fat and protein. Participants fasted for 5 hours after the consumption of test drinks and used continuous glucose monitoring (Dexcom G4 Platinum) to assess postprandial glucose levels.

    Researchers found that participants experienced a delayed and sustained rise in postprandial glucose 3 to 5 hours after consuming the 75 g or 100 g protein drinks, with higher mean excursions of 0.71 mmol/L and 1.06 mmol/L, respectively, during the 180- to 240-minute time interval, and higher mean excursions of 1.65 mmol/L and 1.72 mmol/L, respectively, during the 240- to 300-minute time interval. During the 60- to 120-minute time interval, only the 20 g glucose drink produced a statistically significant glycemic increase (1.97 mmol/L; P < .001). Researchers did not observe a significant postprandial glucose excursion at any point following consumption of either the 12.5 g or 50 g protein drinks.

    “This supports suggestions that insulin for protein-rich meals should ideally be administered using an extended, dual-wave bolus for those using insulin pump therapy” the researchers wrote. “Reduced postprandial glycemic excursions have previously been demonstrated using this bolus function.” – by Regina Schaffer

    Disclosure: The study was supported by a competitive Novo Nordisk Regional Support Scheme Grant, administered by the Australian Pediatric Endocrine Group. The researchers report no relevant financial disclosures.
     
  2. Theo's dad Joe

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    I am surprised at small increases in general. Am I read right that a 10 gram glucose drink did not produce a statistically significant glycemic response during the 60 and 120 minute intervals and that the rise from a 20 gram glucose drink was only 1.97 mmol, or about 35 points? That's less than 2 points per gram. And the 100 gram protein drink only resulted in about 19 points excursion? I am pretty shocked that the 50 gram protein drink produced no significant excursion as well.

    Are these excursions the total rise, or or they a rise in point above target range?
     
    Last edited: Jan 7, 2016
  3. Theo's dad Joe

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    I was going to mention that there are a lot of possible mechanisms. Protein might be being made into glucose, but a 100 gram protein drink is producing a very small effect (most of the recommendations I have read are that about 50-60% of protein should be bolused for, or turns into glucose over several hours).

    Also amino acids can use up insulin if it is available to move into muscle cells. The don't need it but they can use it up, so the amino acids may be using up some basal or bolus that was supposed to be doing something else.

    Also leucine and isoleucine rich proteins like whey (and others) stimulate insulin and glucagon possibly in the gut by stimulating certain cells in the gut lining. If you don't have insulin then you may get a glucagon stimulation without the corresponding insulin, so it may be one of those glucagon malfunction issues with T1D and might have little to do with protein turning into glucose. I have read about some individuals who have experimented on themselves and found that large amounts of very low calorie foods like lettuce could stimulate glucagon (and the one I remember he saw almost a 100 point rise from eating a head of lettuce (several times in several runs, yummy!).

    Also, does the protein have the same effect if it is consumed with carbs versus having one basically eat only protein and then fast for 5 hours which may "turn on" gluconeogenesis.
     

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