Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
Tip 1 Diyabette Protein ve Yağ Sayımı
Protein and Fat Counting in Type 1 Diabetes
Tutku ATUK KAHRAMANa, Zeynep CAFEROĞLUa
aErciyes Üniversitesi Sağlık Bilimleri Fakültesi, Beslenme ve Diyetetik Bölümü, Kayseri, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(1):63-8
doi: 10.5336/pediatr.2020-78185
Article Language: TR
Full Text
ÖZET
 Tip 1 diyabette, hem komplikasyonların önlenmesi hem de metabolik kontrolün sağlanması için, tıbbi beslenme tedavisi büyük önem taşır. Temel beslenme önerilerinin yanı sıra optimal metabolik kontrolün sağlanması için karbonhidrat sayımı tekniği altın standart olarak kabul edilmektedir. Bununla birlikte, son yıllarda yapılan çalışmalarda karbonhidrat sayımı ile ayarlanan insülin dozlarının metabolik kontrolü sağlamada ve kan glukoz değişimini azaltmada yetersiz kaldığı gösterilmiştir. Bu durumun, her ne kadar kan glukoz düzeyleri üzerinde en fazla etkisi olan makro besin ögesi karbonhidratlar olsa da protein ve yağların da etkisinin olmasından kaynaklandığı ileri sürülmektedir. Proteinler, glukoz homeostazını etkileyen hormonlarda değişiklik olması ve glukoneojenik yolaklarla amino asitlerin glukoza dönüşmesi sonucunda kan glukozunu etkiler. Yağlar ise 4 farklı mekanizma ile kan glukozu üzerinde etkilidir, yağların glukoneogenezi, serbest yağ asitlerinin direkt etkisi, hormonlar üzerine etkileri, gastrik boşalma üzerine etkileri. Karbonhidratlı yemeklerde tüketilen protein ve yağ, erken postprandiyal artışı (1-2 saat) azaltmakta ve geç postprandiyal dönemde (3-6 saat) postprandiyal hiperglisemiye katkıda bulunmaktadır. Yağ ve/veya proteinin bu geç glisemik etkisini kapsamak için insülinin etki süresinin uzatılması ve toplam dozun artırılması gerekebilir. Bu nedenle, karbonhidrat dışındaki makro besin ögelerini de içeren alternatif öğün öncesi insülin dozu hesaplama algoritmalarına ihtiyaç oluşmuş ve farklı alternatifler önerilmiştir. Bu derlemede, protein ve yağın postprandiyal glukoz üzerindeki etkileri ile öğün öncesi insülin dozunun belirlenmesinde kullanılabilecek yeni alternatif algoritmalar üzerinde durulmuştur.

Anahtar Kelimeler: Diabetes mellitus; protein; yağ; glukoz; insülin
ABSTRACT
 In type 1 diabetes, medical nutrition therapy is crucial for both preventing complications and maintaining metabolic control. Carbohydrate counting technique is accepted as the gold standard to provide optimal metabolic control as well as basic nutritional recommendations. However, recent studies have shown that pre-meal insulin doses adjusted by carbohydrate counting are insufficient in maintaining metabolic control and reducing blood glucose exchange. This is derived from that proteins and fats also have effects, although macronutrients which the most influential on blood glucose levels are carbohydrates. Proteins affect blood glucose as a result of changes in hormones that affect glucose homeostasis, and conversion of amino acids into glucose by gluconeogenic pathways. Fats are effective on blood glucose with four different mechanisms: gluconeogenesis, the direct effect of free fatty acids, effects on hormones, effects on gastric emptying. Protein and fat consumed in carbohydrate meals reduce early postprandial increase (1-2 hours) and contribute to postprandial hyperglycemia in the late postprandial period (3-6 hours). To cover this late glycemic effect of fat and/or protein, it may be necessary to extend the duration of the insulin and increase the total dose. For this reason, there is a need for alternative pre-meal insulin dose calculation algorithms including macronutrients other than carbohydrates, and different alternatives have been proposed. In this review focuses on the effects of protein and fat on postprandial glucose and new alternative algorithms that can be used to determine the pre-meal insulin dose.

Keywords: Diabetes mellitus; protein; fat; glucose; insulin
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