Higher post-prandial glucose excursions in youth with type 1 diabetes and celiac disease: Time to change the bolus?

Abstract

Newer gluten-free products have been improved in terms of glyce- mic index and glycemic load; however, they may have a higher intake of saturated fat and a lower intake of fibre,6 which could influence postprandial glucose control. Therefore, we highlight the importance of an educational reinforcement on the size and timing of insulin bolus at each meal, in individuals on GFD. Slightly larger boluses (for the same carbohydrate content) when consuming GFD high-GI foods, along with a longer waiting time to reduce peak spikes, should be effective strate- gies for these youths who are monitored with FGM/CGM, as well as increasing fibre intake, which helps slow meal absorption. Other possi- bilities include splitting the bolus: part immediately, part over time (or have a square/dual wave over 1–2 h) to cover both the fast spike and slower tail; or to add a correction bolus after some time (e.g., 1–2 h post-meal) if bolus plus meal leads to earlier spike