Generic placeholder image

Current Diabetes Reviews

Author(s): Elisa Cipponeri*, Cesare Blini, Christian Lamera, Valentina De Mori, Giovanni Veronesi and Antonio Carlo Bossi*

DOI: 10.2174/1573399815666190507121332

DownloadDownload PDF Flyer Cite As
Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study

Page: [619 - 627] Pages: 9

  • * (Excluding Mailing and Handling)

Explore Articles
About Journal
For Authors
For Editors
For Reviewers

Abstract

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.

Keywords: Type 1 diabetes, pump therapy, continuous glucose monitoring, CHO counting, Fat and Protein derived insulin units, alcohol consumption.

[1]
Maiorino MI, Bellastella G, Casciano O, et al. The effects of subcutaneous insulin infusion versus multiple insulin injections on glucose variability in young adults with type 1 diabetes: the 2-year follow-up of the observational METRO study. Diabetes Technol Ther 2018; 20(2): 117-26.
[http://dx.doi.org/10.1089/dia.2017.0334]
[2]
Kulkarni KD. Carbohydrate counting: a practical meal-planning option for people with diabetes. Clin Diabetes 2005; 23: 120-2.
[3]
Shapira G, Yodfat O, HaCohen A. Bolus guide: a novel insulin bolus dosing decision support tool based on selection of carbohydrate ranges. J Diabetes Sci Technol 2010; 4(4): 893-902.
[http://dx.doi.org/10.1177/193229681000400418]
[4]
Yamada E, Okada S, Nakajima Y, et al. Effect of carbohydrate counting using bolus calculators on glycemic control in type 1 diabetes patients during continuous subcutaneous insulin infusion. J Diabetes Investig 2017; 8(4): 496-500.
[http://dx.doi.org/10.1111/dji.12604]
[5]
Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position of the American Diabetes Association. Diabetes Care 2008; 31(Suppl. 1): S61-78.
[http://dx.doi.org/10.2337/dc08-S061]
[6]
DAFNE Study Group.Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325(7367): 746.
[7]
Lowe J, Linjawi S, Mensch M. Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course. Diabetes Res Clin Pract 2008; 80(3): 439-43.
[http://dx.doi.org/10.1016/j.diabres.2008.02.003]
[8]
Laurenzi A, Bolla AM, Panigoni G, et al. Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR). Diabetes Care 2011; 34(4): 823-7.
[http://dx.doi.org/10.2337/dc10-1490]
[9]
Grant L, Lawton J, Hopkins D, et al. Type 1 diabetes structured education: What are the core self-management behaviours? Diabet Med 2013; 30(6): 724-30.
[http://dx.doi.org/10.1111/dme.12164]
[10]
Anderson RM, Funnell MM, Butler PM. Patient empowerment. Results of a randomized controlled trial. Diabetes Care 1995; 18: 943-9.
[11]
Wolpert HA, Atakov-Castillo A, Smith SA. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 2013; 36(4): 810-6.
[http://dx.doi.org/10.2337/dc12-0092]
[12]
Wolever TMS, Mullan YM. Sugars and fat have different effects on postprandial glucose responses in normal and type 1 diabetic subjects. Nutr Metab Cardiovasc Dis 2011; 21: 719-25.
[http://dx.doi.org/10.1016/j.numecd.2010.12.005]
[13]
Bell KJ, Toschi E, Steil GM. Mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management. Diabetes Care 2016; 39(9): 1631-4.
[14]
García-López JM, González-Rodriguez M, Pazos-Couselo M. Should the amounts of fat and protein be taken into consideration to calculate the lunch prandial insulin bolus? Results from a randomized crossover trial. Diabetes Technol Ther 2013; 15(2): 166-71.
[http://dx.doi.org/10.1089/dia.2012.0149]
[15]
Hibbert-Jones E. Fat and protein counting in type 1 diabetes. Pract Diabetes 2016; 33(7): 243-7.
[16]
Paterson M, Bell KJ, O’Connell SM. the role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Curr Diab Rep 2015; 15(9): 61.
[http://dx.doi.org/10.1007/s11892-015-0630-5]
[17]
Bell KJ, Smart CE, Steil GM. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38(6): 1008-15.
[http://dx.doi.org/10.2337/dc15-0100]
[18]
Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 2012; 14(1): 16-22.
[http://dx.doi.org/10.1089/dia.2011.0083]
[19]
Blazik M, Pańkowska E. The effect of bolus and food calculator Diabetics on glucose variability in children with type 1 diabetes treated with insulin pump: the results of RCT. Pediatr Diabetes 2012; 13(7): 534-9.
[http://dx.doi.org/10.1111/j.1399-5448.2012.00876.x]
[20]
Pańkowska E, Błazik M. Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. J Diabetes Sci Technol 2010; 4(3): 571-6.
[21]
Groat D, Soni H, Grando MA. Self-reported compensation techniques for carbohydrate, exercise, and alcohol behaviors in patients with type 1 diabetes on insulin pump therapy. J Diabetes Sci Technol 2018; 12(2): 412-4.
[http://dx.doi.org/10.1177/1932296817718848]
[22]
Grando MA, Groat D, Soni H, et al. Characterization of exercise and alcohol self-management behaviors of type 1 diabetes patients on insulin pump therapy. J Diabetes Sci Technol 2017; 11(2): 240-6.
[http://dx.doi.org/10.1177/1932296816663746]
[23]
Avogaro A, Beltramello P, Gnudi L, et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycemia in IDDM patients. Diabetes 1993; 42(11): 1626-34.
[24]
Tetzschner R, Nørgaard K, Ranjan A. Diabetes Effects of alcohol on plasma glucose and prevention of alcohol-induced hypoglycemia in type 1 diabetes-A systematic review with GRADE. Diabetes Metab Res Rev 2018; 34(3)
[http://dx.doi.org/10.1002/dmrr.2965]
[25]
Kerr D, Macdonald IA, Heller SR. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 (insulin-dependent) diabetes. Diabetologia 1990; 33(4): 216-21.
[26]
Koivisto VA, Tulokas S, Toivonen M. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16(12): 1612-4.
[27]
Plougmann S, Hejlesen O, Turner B. Modelling the effect of alcohol in Type 1 diabetes. Stud Health Technol Inform 2002; 90: 66-71.
[28]
Plougmann S, Hejlesen OK, Cavan DA. DiasNet--a diabetes advisory system for communication and education via the internet. Int J Med Inform 2001; 64(2-3): 319-30.
[29]
Indelicato L, Mariano V, Galasso S, et al. Influence of health locus of control and fear of hypoglycaemia on glycaemic control and treatment satisfaction in people with Type 1 diabetes on insulin pump therapy. Diabet Med 2017; 34(5): 691-7.
[http://dx.doi.org/10.1111/dme.13321]
[30]
McGuire BE, Morrison TG, Hermanns N, et al. Short-form measures of diabetes-related emotional distress: the Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia 2010; 53(1): 66-9.
[http://dx.doi.org/10.1007/s00125-009-1559-5]
[31]
Quandt SA, Ip EH, Kirk JK, et al. Assessment of a short diabetes knowledge instrument for older and minority adults. Diabetes Educ 2014; 40(1): 68-76.
[http://dx.doi.org/10.1177/0145721713508824]
[32]
Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive oil reduces glycemic response to a high-glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care 2016; 39: 518-24.
[http://dx.doi.org/10.2337/dc15-2189]
[33]
Reference: Available from: https://en.wikipedia.org/wiki/ Spritz_(alcoholic_beverage) Accessed 2018, October 29th
[34]
MacNaught N, Holt P. Type 1 diabetes and alcohol consumption. Nurs Stand 2015; 29(50): 41-7.
[http://dx.doi.org/10.7748/ns.29.50.41.e9812]
[35]
Reference: Available from: https://www.theguardian.com/ business/2018/mar/07/coca-cola-launch-first-alcoholic-drink-japan Accessed 2018, October 29th.
[36]
Ismail D, Gebert R, Vuillermin PJ, et al. Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia. Diabet Med 2016 2006; 23(8): 830-3.
[http://dx.doi.org/10.1111/j.1464-5491.2006.01868.x]