Abstract
In a recent publication 1 it was shown that the ingestion of rapidly available carbohydrates by diabetic patients using protamine zinc insulin, resulted in rapid rises and precipitous drops in blood sugar concentration. Such marked fluctuations in blood sugar concentration are no doubt responsible for many of the difficulties encountered in the clinical management of diabetes with protamine zinc insulin. A solution of this problem presents itself in the well-known property of fats in delaying gastro-intestinal activity. To test this hypothesis, 25 patients were given a standard amount of carbohydrate with and without fat. The banana was chosen because of its universal availability, standard composition, palatibility, and ability to be combined with cream.
The patients chosen for this experiment were severe diabetics maintained with protamine zinc insulin exclusively. The tests were carried out in the post-absorptive state, and 24 hours after the last injection of protamine zinc insulin. Blood sugars were determned by the Somogyi modification of the Schaffer-Hartmann method at 1/2 hourly intervals for 4 hours. Each patient received 220 g of banana alone for the preliminary studies, and after 10 days the same amount of banana with 4 ounces of 30% cream.
Within certain variations all patients responded in the same way. Three representative curves were chosen for illustration to show the results and the variations. There are 2 major advantages of the fat-carbohydrate mixture over the carbohydrate alone. The first is the delay in the time of maximum absorption for from 1 to 2 hours. The second is the elimination of the precipitous drop in blood sugar concentration seen with carbohydrate alone.
The advantages of these fat-carbohydrate mixtures when protamine zinc insulin is king used are quite obvious
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