Understanding the utilisation of protein in a restricted carbohydrate environment in Type 1 diabetes

The hypothesis: once habituated to a low carbohydrate diet (75g carbohydrate per day for 4 weeks), an insulin bolus for protein intake is required to maintain glycaemic control, due to gluconeogenesis from protein. The starting point for this bolus is that it will be twice the carbohydrate to insulin ratio. For example, if a patient uses a ratio of 1 unit insulin to 10g carbohydrate, they will use 1 unit to 20g protein. To test this each participant (habituated to a low carbohydrate diet) will undergo 6 meal tests/. The intervention meal tests are meal tests 4-6 (identical): 40g protein + 8g carbs from a protein shake and giving a bolus for carbohydrate and protein. Participants will have baseline glucose checked before starting the meal test, if blood glucose is outside of 4-8mmol then test will be postponed. Meal and insulin bolus will be administered at time 0, blood will be taken at 10, 20, 30, 60, 90, 120, 150, 180 mins. Washout period between meal tests will be 48 hrs.