Summary
The postprandial insulin requirements after three mixed meals of equal carbohydrate and energy content were assessed in 10 type-1 and 12 type-2 diabetics by a glucose-controlled insulin infusion system. These were compared with the glycemic response to the same meals of 10 healthy individuals (glycemic index). In type-1 diabetics, we found the highest insulin requirements after consumption of a continental breakfast (low fibre, low protein, high fat). Ten percent less insulin was infused after milk (low fat, high protein) and 30% less after an English breakfast (high fibre, high protein). Type-2 diabetics showed no significant differences in insulin requirements between the three test meals. The glycemic response in healthy individuals had no relation to these insulin requirements. Continental and English breakfast had a similar glycemic effect, whereas milk produced only 30% of the blood glucose response observed after the continental breakfast. These results indicate that neither the carbohydrate content (exchange lists) nor the glycemic index enable prediction of postprandial insulin requirements in insulin-deficient diabetes. For this purpose, we propose the insulin-need index, elaborated by testing whole meals in closed-loop experiments with type-1 diabetics.
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References
Alvarado F (1986) Transport of sugars and amino acids in the intestine: evidence for a common carrier. Science 151:1010
Anderson JW (1985) Physiological and metabolic effects of dietary fiber. Fed Proc 44:2902–2906
Asp NG, Johansson C-G, Hallmer H, Siljeström M (1983) Rapid enzymatic assay of insoluble and soluble dietary fiber. J Agric Food Chem 31:476–482
Berger S, Vongaraya N (1966) Insulin response to ingested protein in diabetes. Diabetes 15:303–306
Brand JC, Nicholson PL, Thorburn AW, Truswell AS (1985) Food processing and the glycemic index. Am J Clin Nutr 42:1192–1196
Brown JC, Otte SC (1978) Gastrointestinal hormones and the control of insulin secretion. Diabetes 27:782–789
Campbell IW, Ewing DJ, Clarke BF (1981) The quantification of diabetic neuropathy and its clinical significance. In: Owens DR, Irsigler K (eds) New approaches to insulin therapy. MTP Press, Lancaster, pp 425–436
Christiansen JS, Bonnevie-Nielsen C, Svendsen PA, Rubin P, Ronn B, Nerup AJ (1980) Effect of guar gum on 24-hour insulin requirements of insulin-dependent diabetic subjects as assessed by an artificial pancreas. Diabetes Care 3:659–662
Clemens AH, Chag PH, Myers RW (1977) The development of Biostator, a glucose controlled insulin infusion system (GCIIS). Horm Metab Res (Suppl Ser 7):23–33
Collier G, McLean A, O'Dea K (1984) Effect of coingestion of fat on the metabolic response to slowly and rapidly absorbed carbohydrates. Diabetologic 26:50–54
Conn JW, Newburgh LH (1936) The glycemic response to isoglucogenic quantities of protein and carbohydrate. J Clin Invest 15:665–671
Cooke AR (1975) Control of gastric emptying and motility. Gastroenterology 68:804–816
Crapo PA, Kolterman OG, Olefsky JM (1980) Effects of oral fructose in normal, diabetic, and impared glucose tolerance subjects. Diabetes Care 3:575–582
Crapo PA (1986) Carbohydrate in the diabetic diet. J Am Coll Nutr 5:31–34
Creutzfeldt W, Ebert R (1985) New developments in the incretin concept. Diabetologia 28:565–573
O'Dea K, Nestel PJ, Antonoff L (1980) Physical factors influencing postprandial glucose and insulin response to starch. Am J Clin Natr 33:760–765
Desbuquois B, Aurbach GD (1971) Use of polyethylene glycol to separate free and antibody-bound peptide hormones in radioimmunoassays. J Clin Endocrionol 33:732–738
Estrich D, Ravnik A, Schlierf G, Fukayama G, Kinsell L (1967) Effects of co-ingestion of fat and protein upon carbohydrate-induced hyperglycemia. Diabetes 16:232–237
Fajans SS, Floyd JC, Knopf RF, Conn JW (1967) Effect of amino acids and proteins on insulin secretion in man. Recent Prog Horm Res 23:617–623
Floyd JC, Fajans SS, Conn JW, Thiffault C, Knopf RF, Guntsche E (1968) Secretion of insulin induced by amino acids and glucose in diabetes mellitus. J Clin Endocrinol 28:266–276
Gerich JE, Charles MA, Grodsky GM (1976) Regulation of pancreatic insulin and glucagon secretion. Ann Rev Physiol 38:353–388
Goulder TJ, Alberti KGMM, Jenkins DJA (1978) Effect of added fibre on the glucose and metabolic response to a mixed meal in normal and diabetic subjects. Diabetes Care 1:351–355
Haber GB, Heaton KW, Murphy D (1977) Depletion and disruption of dietary fibre. Effects on satiety, plasma-glucose, and serum-insulin. Lancet 1:679–682
Hales CN, Randle PJ (1963) Immunoassay of insulin with an insulin-antibody precipitate. Biochem J 88:137–146
Hall SE, Balton TM, Hetenyi G (1980) The effect of bran on glucose kinetics and plasma insulin in non-insulin-dependent diabetes mellitus. Diabetes Care 3:520–525
Hassinger W, Sauer G, Cordes U, Krause U, Beyer J, Baessler KH (1981) The effects of equal caloric amounts of xylitol, sucrose, and starch on insulin requirements and blood glucose levels in insulin-dependent diabetes. Diabetologia 21:37–40
Hermansen K, Rasmussen O, Arnfeld J, Winther E, Schmitz O (1986) Differential glycemic effects of potato, rice, and spaghetti in type 1 (insulin-dependent) diabetic patients at constant insulinaemia. Diabetologia 29:358–361
Holm J, Björck I, Drews A, Asp N-G (1986) A rapid method for the analysis of starch. Starch 28:224–226
Holt S, Carter DC, Heading RC, Prescott LF, Tothill P (1979) Effect of gel fibre on gastric emptying and absorption of glucose and paracetamol. Lancet: 636–639
Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterton BE, Wishart J, Shearman DJC (1987) Effect of cispride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology 92:1899–1907
Jenkins DJA, Leeds AR, Wolever TMS, Goff DB, Alberti KGMM, Gassull MA, Hockaday TD (1976) Unabsorbable carbohydrates and diabetes: decreased post-prandial hyperglycaemia. Lancet I:172–174
Jenkins DJA, Leeds AR, Gassull MA, Cochet B, Alberti KGMM (1977) Decrease in postprandial insulin and glucose concentrations by guar and pectin. Ann Intern Med 86:20–23
Jenkins DJA, Wolever TMS, Leeds AR, Gassull MA, Haisman P, Dilawari J, Goff DV, Metz GL, Alberti KGMM (1978) Dietary fibres, fibre analogues, and glucose tolerance: importance of viscosity. Br Med J 1:1392–1394
Jenkins DJA, Wolever TMS, Taylor RH, Ghafari H, Jenkins AL, Barker H, Jenkins MJA (1980) Rate of digestion of foods and postprandial glycaemia in normal and diabetic subjects. Br Med J 281:14–17
Jenkins DJA, Wolever TMS, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV (1981) Glycemic index of foods: a physiologic basis for carbohydrate exchange. Am J Clin Nutr 34:362–366
Morrison DF (1967) Multivariate statistical methods. McGraw-Hill, New York, p 141ff
Moskowitz E (1937) Der Einfluß vegetabiler Nahrungsmittel auf den Blutzucker bei Diabetikern. Z Klin Med 131:648–659
Nauck M, Stöckmann F, Ebert R, Creuzfeldt W (1986) Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia 29:46–52
Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowsky P (1984) Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 7:465–470
Nuttall FQ, Gannon MC, Wald JL, Ahmed M (1985) Plasma glucose and insulin profiles in normal subjects ingesting diets of varying carbohydrate, fat, and protein content. J Am Coll Nutr 4:437–450
Paul AA, Southgate DAT (1978) McCance and Widdowson's, The composition of foods, 4th edn. HMSO, 1978, MRC Special Report No 297, Biochemical Press, Elsevier/North-Holland, London
Pfeifer MA, Halter JB, Porte D (1981) Insulin secretion in diabetes mellitus. Am J Med 70:579–588
Rabinowitz D, Maffezzoli R, Merimee TJ, Burgess JA (1966) Patterns of hormonal release after glucose, protein and glucose plus protein. Lancet I:454–456
Ross SA, Dupré J (1978) Effects of ingestion of triglyceride or galactose on secretion of gastric inhibitory polypeptide and on responses to intravenous glucose in normal and diabetic subjects. Diabetes 27:327–333
Schauberger G, Brinck VC, Guldner G, Spaethe R, Niklas L, Otto H (1978) Exchange of carbohydrates according to their effect on blood gluscose. Diabetes 26:415
Schrezenmeir J, Bartram HP, Eilles C, von Aerssen M, Kasper H (1984) Relationships between the cardiovascular and gastrointestinal systems: biphasic glucose response to a meal — a typical find of gastric involvement in ADN. Diabetologia 27:329–340
Schrezenmeir J, Achterberg H, Bergerle J, Küstner E, Stürmer W, Hutten H, Beyer J (1985) Computer-assisted meal-related therapy (CAMIT). In: Beyer J, Albisser M, Schrezenmeir J, Lehmann L (eds) Computer systems for insulin adjustment in diabetes mellitus. Panscientia/Switzerland, Hedingen, pp 133–144
Schrezenmeir J, Achterberg H, Bergerle J, Küstner E, Stürmer W, Hutten H, Beyer J (1985) Controlled study on the use of hand-held insulin dosage computers enabling conversion to and optimizing of meal-related insulin therapy regimes. Life Support Systems 3 (Suppl 1):561–567
Schrezenmeir J, Tatò F, Tatò S, Müller-Haberstock S, Achterberg H, Stürmer W, Hogan M, Beyer J (1987) Algorithms for CSII-quantified approach to a basal rate and meal-induced requirements. In: Brunetti P, Waldhäusl WK (eds) Advanced models for the therapy of insulin-dependent diabetes (Serono Symp Publ Raven Press, New York, pp 191–197
Slama G, Klein J-C, Delage A, Ardila E, Lemaiguen H, Papoz L, Thobroutsky G (1981) Correlation between the nature and amount of carbohydrate in meal intake and insulin delivery by the artificial pancreas in insulin-dependent diabetics. Diabetes 30:101–105
Souci SW, Fachmann W, Kraut H (1981) Die Zusammensetzung der Lebensmittel, Nährwerttabellen 1981/82. Wissenschftl Verlagsges Stuttgart
Swann DC, Davidson P, Albrink MJ (1966) Effect of simple and complex carbohydrates on plasma nonesterified fatty acids, plasma-sugar, and plasma insulin during oral carbohydrate tolerance tests. Lancet I:60–63
Tunali G, Cremer H-D, Huth K (1976) Verleichende Untersuchungen der Glucose- und Galactoseassimilation bei Verabfolgung von Füll- und Quellstoffen. Akt Ernährung 2:76–78
Unger RH (1985) Glucagon physiology and pathophysiology in the light of new advances. Diabetologia 28:574–578
Wahlqvist ML, Willmshurst EG, Murton CR, Richardson EN (1978) The effect of chain length on glucose absorption and related metabolic response. Am J Clin Nutr 31:1998–2001
Wakhloo AK, Beyer J, Diederich C, Schulz G (1984) Einfluß von Nahrungsfett auf Blutzuckerspiegel und Insulinverbrauch nach Einnahme verschiedener Kohlenhydratträger bei Typ I-Diabetikern am künstlichen Pankreas. Dtsch Med Wochenschr 109:1589–1594
Wolever TMS, Nuttall FQ, Lee R, Wong GS, Josse RG, Csima A, Jenkins DJA (1985) Prediction of the relative blood glucose response of mixed meals using the white bread glycemic index. Diabetes Care 8:418–428
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Schrezenmeir, J., Tatò, F., Tatò, S. et al. Comparison of glycemic response and insulin requirements after mixed meals of equal carbohydrate content in healthy, type-1, and type-2 diabetic man. Klin Wochenschr 67, 985–994 (1989). https://doi.org/10.1007/BF01716062
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DOI: https://doi.org/10.1007/BF01716062