الفهرس 
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Abstract
High fat and protein contents of meals affect the postprandial blood glucose levels for an extended period of time after the meal and required significantly more insulin than low fat low protein meals with the same amount of carbohydrates. This study aimed to assess of the effect of splitting mealtime bolus insulin dose on the post prandial blood glucose levels in the first 6 hours after mixed meals high in fat and protein in children and adolescents with T1DM using MDI.
The current study compared the effect of 3 different insulin dosing strategies on the postprandial blood glucose levels in the 6 hours following a mixed fat and protein meal in 43 children and adolescents with T1DM using the MDI regimen. The first intervention (Intervention A) involved the use of premeal insulin dose (insulin lispro) calculated according to the carbohydrate content of the meal and the individual ICR with an additional correction insulin dose (insulin lispro) calculated according to the individual ISF given 3 hours after the meal if the blood glucose level was higher than the target range (> 180 mg/dL). The second intervention (Intervention B) involved the use of a 130% of the insulin dose calculated according to the individual ICR splitted into a pre-meal portion (60% of the total dose) given 10 minutes before the meal and a post-meal portion (40% of the total dose) given 30 minutes after the pre-meal dose, with both the premeal and post-meal portions given as insulin lispro. The third intervention (Intervention C) was exactly the same as the second intervention with the exception that the post-meal dose was given as regular insulin.
The study found that there was a statistically significant difference between the 3 interventions in the blood glucose level at 3 hours after the meal, with higher blood glucose level with intervention A. The study demonstrated that intervention C had significantly lower total and late blood glucose AUC compared to intervention A. Moreover, intervention C had significantly lower late blood glucose AUC compared to intervention B. On the other hand, there were no significant differences between the 3 interventions regarding the early blood glucose AUC.
The study did not find significant differences between the 3 interventions regarding the percentages of participants with postprandial blood glucose levels below the target range or the percentages of participants with mild or severe hypoglycemia. Severe hypoglycemia occurred with 3 (7.0%), 2 (4.7%) and 4 (9.3%) of the participants with intervention A, B and C, respectively. However, the current study did not find significant differences between the 3 interventions regarding the times to the peak or to the lowest postprandial blood glucose level, the maximum or the minimum postprandial blood glucose levels, the postprandial blood glucose range (calculated as the differences between the maximum and the minimum postprandial blood glucose levels) or the percentages of participants with postprandial blood glucose levels above the target range (> 180 mg/dL)
The study did not find any significant correlations between serum cholesterol levels and serum triglycerides levels at 3 hours after the test meal and different variables related to postprandial glycemic responses among the study participants following each of the 3 interventions.
In conclusion , the use of an additional 30% of insulin dose calculated according to the ICR for mixed fat and protein meals in children and adolescents with T1DM using MDI regimen, with splitting of the total dose into 60% given 10 minutes for the meal as fast-acting insulin analog and 40% given 30 minutes after the meal as regular insulin provided better postprandial glycemic control with lower blood glucose rise 3 hours after the meal and lower late blood glucose area under the curve (3 – 6 hour) without increase in the risk for development of hypoglycemia.