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Steil, Garry

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Steil

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Garry

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Steil, Garry

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2014 - 20152

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Author's Publications: search.filters.isAuthorOfPublication.96a29d40-a7a5-4241-83df-130f96455367

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Now showing 1 - 2 of 2
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    Tight glycemic control in the ICU - is the earth flat?
    (BioMed Central, 2014) Steil, Garry; Agus, Michael
    Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
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    Bolus Estimation—Rethinking the Effect of Meal Fat Content
    (Mary Ann Liebert, Inc., 2015) Laxminarayan, Srinivas; Reifman, Jaques; Edwards, Stephanie S.; Wolpert, Howard A.; Steil, Garry
    Abstract Background: Traditionally, insulin bolus calculations for managing postprandial glucose levels in individuals with type 1 diabetes rely solely on the carbohydrate content of a meal. However, recent studies have reported that other macronutrients in a meal can alter the insulin required for good postprandial control. Specifically, studies have shown that high-fat (HF) meals require more insulin than low-fat (LF) meals with identical carbohydrate content. Our objective was to assess the mechanisms underlying the higher insulin requirement observed in one of these studies. Materials and Methods: We used a combination of previously validated metabolic models to fit data from a study comparing HF and LF dinners with identical carbohydrate content in seven subjects with type 1 diabetes. For each subject and dinner type, we estimated the model parameters representing the time of peak meal-glucose appearance (τm), insulin sensitivity (SI), the net hepatic glucose balance, and the glucose effect at zero insulin in four time windows (dinner, early night, late night, and breakfast) and assessed the differences in model parameters via paired Wilcoxon signed-rank tests. Results: During the HF meal, the τm was significantly delayed (mean and standard error [SE]: 102 [14] min vs. 71 [4] min; P = 0.02), and SI was significantly lower (7.25 × 10−4 [1.29 × 10−4] mL/μU/min vs. 8.72 × 10−4 [1.08 × 10−4] mL/μU/min; P = 0.02). Conclusions: In addition to considering the putative delay in gastric emptying associated with HF meals, we suggest that clinicians reviewing patient records consider that the fat content of these meals may alter SI.