The glycaemic effect of simple sugars in mid-morning and afternoon snacks in childhood diabetes

The snack is critical for the blood glucose profile during treatment with regular insulin preprandially

OBJECTIVES

To evaluate how a snack influences the blood glucose profile during treatment with preprandial regular human insulin.

DESIGN

In a randomized study a mid-morning snack either was or was not served. Insulin was given 30 min before the usual breakfast of the patients. Plasma free insulin and blood glucose were repeatedly determined for 5 h.

SETTING

Outpatient clinic at a university hospital.

SUBJECTS

Twenty patients with type 1 diabetes treated with multiple injections of regular insulin (Actrapid) and eight non-diabetic subjects.

INTERVENTIONS

A mid-morning snack either was or was not served 2 h after the usual morning insulin injection.

MAIN OUTCOME MEASURES

A difference in the blood glucose profile after a mid-morning snack.

RESULTS

With a snack there was no difference in blood glucose fasting and at 12.30 h, whilst without a snack there was a decrease of almost 4 mmol L-1, several patients experienced low blood glucose and three had hypoglycaemia. An extended peak of free insulin was reached 30 min after the insulin injection with a slow decrease to the fasting level after 5 h. After the insulin injection a significant decrease in blood glucose occurred within 30-45 min.

CONCLUSIONS

A snack 2 h after the insulin injection results in a smoother blood glucose profile and reduces the risk of hypoglycaemia in patients with type 1 diabetes treated with preprandial regular human insulin. Furthermore, the recommended interval of 30 min between insulin injection and a meal may be too long.

Lower glycemic response to sucrose in the diets of children with type 1 diabetes

OBJECTIVE

To compare glycemic responses of isocaloric mixed meals containing 2% and 17% sucrose in children with type 1 diabetes who had fasting euglycemia.

STUDY DESIGN

Nine children (11 to 16 years) with type 1 diabetes were randomized in a crossover design to receive 2 isocaloric diets (2% or 17% sucrose) in the Clinical Research Center. In the 2% sucrose diet, starch isocalorically replaced sucrose.

RESULTS

Fasting euglycemia was comparable on both study days (mean +/- SEM: 2% sucrose, 5.0 +/- 0.3 mmol/L or 90 +/- 5 mg/dL; 17% sucrose, 5.0 +/- 0.3 mmol/L or 91 +/- 6 mg/dL). The 17% sucrose diet resulted in a lower glycemic response than the 2% sucrose diet over the 4-hour study period (area under glucose response curve: mean +/- SEM, 37 +/- 3.5 mmol/L x 4 h vs 42 +/- 4.7 mmol/L x 4 h, P = .01). Peak blood glucose response was earlier and lower (2.2 to 2.8 mmol/L, 40 to 50 mg/dL) with the 17% sucrose diet.

CONCLUSIONS

Sucrose in moderate amounts, isocalorically exchanged for starch, lowered glycemic response between breakfast and lunch in children who were euglycemic before breakfast. These data refute concerns about adverse glycemic effects of sucrose and support the use of sucrose-containing foods in the context of a healthy meal plan.

Controlled portions of presweetened cereals present no glycemic penalty in persons with insulin-dependent diabetes mellitus

OBJECTIVE

To determine metabolic responses to commercially sweetened flaked corn cereal, unsweetened flaked corn cereal, glucose, and sucrose in teenagers and young adults with insulin-dependent diabetes mellitus (IDDM).

DESIGN

A crossover design in which each subject consumed test meals in random order on 4 separate days at least 72 hours apart.

SETTING

The inpatient setting of the General Clinical Research Center of the Indiana University Medical Center Hospital.

SUBJECTS

Sixteen males and eight females, aged 14 to 25 years, with IDDM.

INTERVENTIONS

After fasting overnight, each subject underwent challenge tests with 50 g carbohydrate per 1.73 m2 of body surface area from sweetened flaked corn cereal, unsweetened flaked corn cereal, sucrose, and glucose. All subjects were maintained on continuous intravenous infusion of insulin overnight (euglycemic goal = 3.9 to 6.7 mmol/L), with a constant basal insulin dose infused before and throughout a 3-hour postprandial period.

MAIN OUTCOME MEASURES

Plasma glucose, free insulin, triglycerides, and free fatty acid levels measured at baseline and 15, 30, 45, 60, 90, 120, 150, and 180 minutes after meals.

STATISTICAL ANALYSES PERFORMED

Comparisons among the four meals were made using two-way repeated measures analyses of variance followed by the Newman-Keuls multiple comparison procedure to identify specific differences among meals. The areas under the response curves were compared using one-way repeated measures analysis of covariance, adjusted for baseline values.

RESULTS

The response to glucose for the area under the 3-hour blood glucose response curve was significantly greater than the response to sucrose (P = .006 by repeated measures analysis of variance); the areas for the two cereals (not significantly different from one another) were between the glucose and sucrose areas. At 3 hours, glycemia differed significantly among three of the meals: unsweetened flaked corn cereal > sweetened flaked corn cereal > sucrose (P < .001). Glucose at 3 hours was greater than sucrose (P < .001). There were no significant differences for free insulin, triglycerides, or free fatty acids.

APPLICATIONS

Equivalent gram amounts of carbohydrate as presweetened breakfast cereals are not detrimental to persons with IDDM compared with unsweetened cereals. Therefore, presweetened cereals can be used in the correct portion sizes and based on the number of carbohydrate or starch servings in a person's diabetic meal plan.

Effect of the introduction of dietary sucrose on metabolic control in children and adolescents with type I diabetes

The effect of sucrose in the diet of children and adolescents with type I diabetes on long-term metabolic control was studied. For a mean observation period of 83 (range 42-127) days, a diet containing 5% of total calories as refined sugar was recommended to 11 children (group A, mean age 15.0, SD 5.4 years), while another 13 children remained on their usual 'sucrose-free' diet (group B, mean age 16.0, SD 5.7 years). The mean observation period in this group was 77 (41-103) days. All children had a dietary assessment at baseline and at follow up using a 7-day food record. At baseline, sucrose intake as a proportion of total daily calories was similar in the two groups (group A 1.4, SD 1.9% vs group B 2.0, SD 2.3%; P = 0.5). At follow-up, sucrose intake increased significantly in group A (5.1, SD 2.5%; P = 0.0008) but not in group B (2.7, SD 3.3%; P = 0.5). Metabolic control assessed by haemoglobin level (HbA1c) was not different between the groups at baseline (group A 8.5, SD 1.2 vs group B 8.8, SD 1.8%; P = 0.7) nor at follow-up (9.1, SD 1.4 vs 9.0, SD 2.5%; P = 0.9). Within group A, the individual change in HbA1c correlated with the individual change in sucrose intake (r = 0.61, P = 0.05), this correlation being strongly influenced by two individuals with an increase in sucrose consumption substantially exceeding 5%. Percentage intake of protein, carbohydrate and fat did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycaemic effect and satiating capacity of potato chips and milk chocolate bar as snacks in teenagers with diabetes

In 14 adolescents with diabetes, the postprandial blood glucose, after ingestion of two popular snacks, milk chocolate bar and potato chips, was compared to a prescribed mid-afternoon snack that was isocaloric with the comparison snacks. The prescribed diabetes snack consisted of wholemeal wheat bread, margarine, cheese and apple (1533 kJ/365 kcal): 14% protein, 32% fat and 54% carbohydrate. The milk chocolate bar and the potato chips contained 4% protein, 55% fat and 41% carbohydrate. The mean blood glucose peak was 4.7 (+/- 0.8) mmol/l after the regular diabetes snack, after the milk chocolate bar 2.9 (+/- 0.6) mmol/l, and 3.2 (+/- 0.6) mmol/l after the potato chips (P > 0.05). The mean incremental area under the blood glucose curve was 450.3 (+/- 105.5) mmol/l x 180 min for the regular diabetes snack, 269.5 (+/- 96.7) mmol/l x 180 min for the milk chocolate bar and 191.7 (+/- 95.0) mmol/l x 180 min for the potato chips (P > 0.05). We conclude that an occasional exchange of a regular diabetes afternoon snack for an isocaloric amount of milk chocolate bar or potato chips has no negative impact on the postprandial blood glucose.