Vergleich von zwei Protokollen zur Durchführung eines Fastentages zur Überprüfung der basalen Insulinsubstitution bei Typ-1-Diabetes: Konsequentes Fasten im Vergleich zur Erlaubnis einer Kost mit vernachlässigbarem Kohlenhydrat- und Kaloriengehalt

Vergleich von zwei Protokollen zur Durchführung eines Fastentages zur Überprüfung der basalen Insulinsubstitution bei Typ-1-Diabetes: Konsequentes Fasten im Vergleich zur Erlaubnis einer Kost mit vernachlässigbarem Kohlenhydrat- und Kaloriengehalt

Comparison of basal rate tests (24-hour fasts) performed in type-1-diabetic subjects with either absolute fasting or snacks containing negligible carbohydrate amounts

Maike Haase

Doctoral thesis

Date of Examination: 2018-03-20

Date of issue: 2018-03-20

Advisor: Nauck, Michael A. Prof. Dr.

Referee: Nauck, Michael A. Prof. Dr.

Referee: Raddatz, Dirk Prof. Dr.

Referee: Oppermann, Martin Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-002E-E391-3

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Abstract

English

Aims: Basal rate tests (24-hour fasting periods) may be necessary to optimize basal insulin replacement in type 1 diabetes. It was the aim of this study to prospectively compare the allowance of negligible carbohydrate snacks vs absolute fasting. Methods: A total of 20 patients with type 1 diabetes (age, 48 ± 15 years (9 women, 11 men); BMI, 28.5 ± 4.5 kg/m2; HbA1c, 8.8% ± 2.0% (73.0 ± 21.9 mmol/mol); insulin dose, 0.69 ± 0.31 IU/kg body weight and per day) participated in 2 basal rate tests lasting 24 hours in random order with unchanged basal insulin replacement. On 1 occasion, negligible carbohydrate snacks (salads and vegetables, up to 5.1 g carbohydrate and 276.3 kJ per portion) were allowed; during the second test subjects were obliged to fast absolutely. Plasma glucose profiles were determined using an exact laboratory method. Hypoglycaemic episodes (plasma glucose < 70 mg/dL) were compared. Results: Plasma glucose concentrations during fasting periods, with and without negligible carbohydrate snacks, did not differ significantly (P = .65) and differences were negligible (95% confidence intervals always included a difference of 0 mmol/L). Also, there was no difference in the number of hypoglycaemic plasma glucose values (P = .40) or in compensatory carbohydrate intake. Basal rate testing with negligible carbohydrate snacks was better tolerated (questionnaire, P = .046) and the desire to discontinue the fasting period was significantly reduced (P = .023). Conclusions: Allowing negligible carbohydrate snacks results in unchanged plasma glucose profiles during basal rate testing and is better tolerated by patients with type 1 diabetes.

Keywords: basal insulin replacement; basal rate test; fasting; hypoglycaemia; intensified insulin regimen; multiple daily insulin injections; type 1 diabetes