Dietary PI contributes to PPH in T1D patients. Current recommendations are to increase insulin dose for mixed meals containing ≥ 40 gm of protein, and consider insulin dosing for pure-protein meals containing ≥75 gm of protein. There are no studies to date that investigate this effect specifically in children and in relation to body weight. Our aim was to explore the role of weight and other demographic factors in the relationship between PI and PPH in children with T1D, hypothesizing that the protein amount that causes PPH in children with T1D is weight based. We conducted a self-controlled, prospective study, in children with T1D who were given Whey protein isolate drinks (carbohydrate and fat free) of varying protein amounts (0, 12.5, 25, 37.5, 50, and 62.5 gm) on 6 different nights based on a protocol approved by UHIRB. The glucose levels were monitored with the participants’ personal continuous glucose monitors for 5 hours post PI. PPH was defined as glucose elevations ≥ 50 mg/dL above baseline. Thirty-eight subjects were recruited and 11 subjects (6 females, 5 males) completed the intervention. Subjects had a mean (SD) age of 11.6 (3.5) years, diabetes duration of 6.1 (4.7) years, HbA1c of 7.2 (0.8) %. BMI %ile ranged from 8th to 87th. PPH was detected at 5 hours post PI in 1/11, 5/11, 6/10, 6/9, 5/9, and 8/9 subjects after receiving 0, 12.5, 25, 37.5, 50, and 62.5 gm, respectively. There were no significant correlations between the rise in glucose and body weight, however for those with BMI %ile > 50% (n=8), BMI %ile was strongly correlated with change in glucose for doses 37.5 (all rs > 0.85, all p <0.01) and 50 gm (all rs > 0.64, all p <0.08) for all times. The correlation was somewhat less for 62.5 gm (all rs > 0.52). This suggests that the protein amount associated with PPH in children with TID is less than the threshold (75 gm) found in previous studies mainly consisting of adults.
D. Dalle: None. S.G. Shahmirian: None. M. O'Riordan: None. T.N. Zimmerman: Research Support; Spouse/Partner; Merck & Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Spouse/Partner; Merck Foundation. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.