Akademik Veri Yönetim Sistemi
Turkiye Klinikleri Pediatri, cilt.30, sa.1, ss.63-68, 2021 (Scopus)
© 2021 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).In type 1 diabetes, medical nutrition therapy is crucial for both preventing complications and maintaining metabolic control. Carbohydrate counting technique is accepted as the gold standard to provide optimal metabolic control as well as basic nutritional recommendations. However, recent studies have shown that pre-meal insulin doses adjusted by carbohydrate counting are insufficient in maintaining metabolic control and reducing blood glucose exchange. This is derived from that proteins and fats also have effects, although macronutrients which the most influential on blood glucose levels are carbohydrates. Proteins affect blood glucose as a result of changes in hormones that affect glucose homeostasis, and conversion of amino acids into glucose by gluconeogenic pathways. Fats are effective on blood glucose with four different mechanisms: gluconeogenesis, the direct effect of free fatty acids, effects on hormones, effects on gastric emptying. Protein and fat consumed in carbohydrate meals reduce early postprandial increase (1-2 hours) and contribute to postprandial hyperglycemia in the late postprandial period (3-6 hours). To cover this late glycemic effect of fat and/or protein, it may be necessary to extend the duration of the insulin and increase the total dose. For this reason, there is a need for alternative pre-meal insulin dose calculation algorithms including macronutrients other than carbohydrates, and different alternatives have been proposed. In this review focuses on the effects of protein and fat on postprandial glucose and new alternative algorithms that can be used to determine the pre-meal insulin dose.