{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T21:27:11Z","timestamp":1785878831870,"version":"3.56.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the insulin requirement for a high\u2010fat, high\u2010protein breakfast to optimise postprandial glycaemic excursions in children and young people with type 1 diabetes using insulin pumps.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In all, 27 participants aged 10\u201323\u00a0years, BMI &lt;95<jats:sup>th<\/jats:sup> percentile (2\u201318\u00a0years) or BMI &lt;30\u00a0kg\/m<jats:sup>2<\/jats:sup> (19\u201325\u00a0years) and HbA<jats:sub>1c<\/jats:sub> \u226464\u00a0mmol\/mol (\u22648.0%) consumed a high\u2010fat, high\u2010protein breakfast (carbohydrate: 30\u00a0g, fat: 40\u00a0g and protein: 50\u00a0g) for 4\u00a0days. In this cross\u2010over trial, insulin was administered, based on the insulin\u2010to\u2010carbohydrate ratio (ICR) of 100% (control), 120%, 140% and 160%, in an order defined by a randomisation sequence and delivered in a combination bolus, 60% \u00bc hr pre\u2010meal and 40% over 3\u00a0hr. Postprandial sensor glucose was assessed for 6\u00a0hr.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Comparing 100% ICR, 140% ICR and 160% ICR resulted in significantly lower 6\u2010hr areas under the glucose curves: mean (95%CI) (822\u00a0mmol\/L.min [605,1039] and 567 [350,784] vs 1249 [1042,1457], <jats:italic>p<\/jats:italic>\u00a0\u2264\u00a00.001) and peak glucose excursions (4.0\u00a0mmol\/L [3.0,4.9] and 2.7 [1.7,3.6] vs 6.0 [5.0,6.9],<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Rates of hypoglycaemia for 100%\u2010160% ICR were 7.7%, 7.7%, 12% and 19% respectively (<jats:italic>p<\/jats:italic>\u00a0\u2265\u00a00.139). With increasing insulin dose, a step\u2010wise reduction in mean glucose excursion was observed from 1 to 6\u00a0hr (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incrementally increasing the insulin dose for a high\u2010fat, high\u2010protein breakfast resulted in a predictable, dose\u2010dependent reduction in postprandial glycaemia: 140% ICR improved postprandial glycaemic excursions without a statistically significant increase in hypoglycaemia. These findings support a safe, practical method for insulin adjustment for high\u2010fat, high\u2010protein meals that can be readily implemented in practice to improve postprandial glycaemia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14511","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T05:44:34Z","timestamp":1610084674000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["In children and young people with type 1 diabetes using Pump therapy, an additional 40% of the insulin dose for a high\u2010fat, high\u2010protein breakfast improves postprandial glycaemic excursions: A cross\u2010over trial"],"prefix":"10.1111","volume":"38","author":[{"given":"Tenele A.","family":"Smith","sequence":"first","affiliation":[{"name":"Faculty of Health and Medicine University of Newcastle Callaghan Australia"},{"name":"Hunter Medical Research Institute New Lambton Heights Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3104-8800","authenticated-orcid":false,"given":"Carmel E.","family":"Smart","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medicine University of Newcastle Callaghan Australia"},{"name":"Hunter Medical Research Institute New Lambton Heights Australia"},{"name":"Department of Paediatric Endocrinology John Hunter Children's Hospital New Lambton Heights, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle E. 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