Controlled portions of presweetened cereals present no glycemic penalty in persons with insulin-dependent diabetes mellitus

Objective To determine metabolic responses to commercially sweetened flaked corn cereal, unsweetened flaked corn cereal, glucose, and sucrose in teenagers and young adults with insulin-dependent diabetes mellitus (IDDM). Design A crossover design in which each subject consumed test meals in random order on 4 separate days at least 72 hours apart. Setting The inpatient setting of the General Clinical Research Center of the Indiana University Medical Center Hospital. Subjects Sixteen males and eight females, aged 14 to 25 years, with IDDM. Interventions After fasting overnight, each subject underwent challenge tests with 50 g carbohydrate per 1.73 m2 of body surface area from sweetened flaked corn cereal, unsweetened flaked corn cereal, sucrose, and glucose. All subjects were maintained on continuous intravenous infusion of insulin overnight (euglycemic goal=3.9 to 6.7 mmol/L), with a constant basal insulin dose infused before and throughout a 3-hour postprandial period. Main outcome measures Plasma glucose, free insulin, triglycerides, and free fatty acid levels measured at baseline and 15, 30, 45, 60, 90, 120, 150, and 180 minutes after meals. Statistical analyses performed Comparisons among the four meals were made using two-way repeated measures analyses of variance followed by the Newman-Keuls multiple comparison procedure to identify specific differences among meals. The areas under the response curves were compared using one-way repeated measures analysis of covariance, adjusted for baseline values. Results The response to glucose for the area under the 3-hour blood glucose response curve was significantly greater than the response to sucrose (P=.006 by repeated measures analysis of variance); the areas for the two cereals (not significantly different from one another) were between the glucose and sucrose areas. At 3 hours, glycemia differed significantly among three of the meals: unsweetened flaked corn cereal>sweetened flaked corn cereal>sucrose (P<.001) Glucose at 3 hours was greater than sucrose (P<.001). There were no significant differences for free insulin, triglycerides, or free fatty acids. Applications Equivalent gram amounts of carbohydrate as presweetened breakfast cereals are not detrimental to persons with IDDM compared with unsweetened cereals. Therefore, presweetened cereals can be used in the correct portion sizes and based on the number of carbohydrate or starch servings in a person's diabetic meal plan.