Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study

BACKGROUND

There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or "happy hours".

INTRODUCTION

This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif ("Spritz" and chips).

METHODS

Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting.

RESULTS

After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected.

CONCLUSION

Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.

Bone Morphogenetic Protein-6 Attenuates Type 1 Diabetes Mellitus-Associated Bone Loss

Patients with type 1 diabetes mellitus (T1DM) often suffer from osteopenia or osteoporosis. Although most agree that T1DM-induced hyperglycemia is a risk factor for progressive bone loss, the mechanisms for the link between T1DM and bone loss still remain elusive. In this study, we found that bone marrow-derived mesenchymal stem cells (BMSCs) isolated from T1DM donors were less inducible for osteogenesis than those from non-T1DM donors and further identified a mechanism involving bone morphogenetic protein-6 (BMP6) that was produced significantly less in BMSCs derived from T1DM donors than that in control cells. With addition of exogenous BMP6 in culture, osteogenesis of BMSCs from T1DM donors was restored whereas the treatment of BMP6 seemed not to affect non-T1DM control cells. We also demonstrated that bone mineral density (BMD) was reduced in streptozotocin-induced diabetic mice compared with that in control animals, and intraperitoneal injection of BMP6 mitigated bone loss and increased BMD in diabetic mice. Our results suggest that bone formation in T1DM patients is impaired by reduction of endogenous BMP6, and supplementation of BMP6 enhances osteogenesis of BMSCs to restore BMD in a mouse model of T1DM, which provides insight into the development of clinical treatments for T1DM-assocaited bone loss. Stem Cells Translational Medicine 2019;8:522-534.

Late to the Party: Importance of Dietary Fat and Protein in the Intensive Management of Type 1 Diabetes. A Case Report

Insulin dosing in type 1 diabetes (T1D) has been focused primarily on carbohydrate intake, but recent evidence highlights the importance of dietary fat and protein in glycemic excursions. Several methods have been developed to incorporate dietary fat and protein into insulin dose calculations, including fat–protein units (FPUs) that estimate insulin requirements based on ingested fat and protein, as well as extended combination insulin boluses. However, insulin dosing based on meal fat and protein content is challenging to incorporate into clinical practice.

We present the case of a 40-year-old man with T1D using continuous subcutaneous insulin infusions and continuous glucose monitoring. He followed a diet that restricted carbohydrate intake, with compensatory increases in dietary protein and fat. He had poor glycemic control with frequent postprandial hyperglycemia. He began incorporating FPUs into his insulin dosing calculations and used extended dual wave boluses to administer prandial insulin. Over the next 6 months he experienced a significant improvement in glycemic control.

Fat and protein have both been shown to cause delayed postprandial hyperglycemia, leading to poor glycemic control with carbohydrate-focused insulin dosing in our patient on a high-fat, high-protein diet. It is difficult to incorporate dietary fat and protein into insulin dosing in the clinical setting. However, our patient experienced an improvement in glycemic control with the application of FPUs and dual wave boluses in prandial insulin dosing, showing that methods such as these can be used successfully in T1D management.