The impact of dietary fat and protein on postprandial glycemia in type 1 diabetes (T1D) and the need to adjust for them in the mealtime insulin dose have been controversial (1,2). Recently, carefully designed randomized trials in individuals living with T1D have shown protein and fat consumed in meals with carbohydrate reduce the early postprandial rise (1–2 h) and contribute to postprandial hyperglycemia in the late (3–6 h) postprandial period (3–5). In clinical practice, continuous glucose monitoring highlights the glycemic effects of different meal types demonstrating that mealtime insulin dosing strategies based on carbohydrate counting alone have limitations. There is a need for an evidence-based, safe, and practical method to guide insulin adjustments for high-fat, high-protein meals. In this issue of Diabetes Care, Bell et al. (6) address the pressing clinical question of optimal insulin adjustments for meals containing differing amounts of dietary fat. This is important because postprandial hyperglycemia has been identified as a risk factor for the development of long-term complications of diabetes (7), and higher fat diets have increased in popularity in recent years.

中文翻译：

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胰岛素定量摄取脂肪和蛋白质：是时候了吗？

在1型糖尿病（T1D）中饮食脂肪和蛋白质对餐后血糖的影响以及就餐时胰岛素剂量的调整需求一直存在争议（1,2）。最近，精心设计的针对T1D患者的随机试验显示，碳水化合物饮食中消耗的蛋白质和脂肪减少了餐后早期升高（1-2小时），并在餐后晚期（3-6小时）导致了餐后高血糖（3）。 –5）。在临床实践中，连续的血糖监测突显了不同膳食类型的血糖作用，表明仅基于碳水化合物计数的进餐时间胰岛素剂量策略存在局限性。需要一种循证，安全和实用的方法来指导高脂，高蛋白餐的胰岛素调整。在本期糖尿病护理中，贝尔等。（6）解决了针对饮食中含有不同量的饮食脂肪的最佳胰岛素调节的紧迫临床问题。这很重要，因为餐后高血糖已被确定为糖尿病长期并发症发展的危险因素（7），并且近年来高脂饮食的受欢迎程度有所提高。