BACKGROUND: Continuous subcutaneous insulin infusion is considered a safe and effective way to administer insulin in pediatric patients with type 1 diabetes, but achieving satisfactory and stable glycemic control is difficult. Several factors contribute to control, including fine-tuning the basal infusion rate and bolus timing. We evaluated the most effective timing of a pump-delivered, preprandial bolus in children with type 1 diabetes. METHODS: We assessed the response of 30 children with type 1 diabetes to a standard meal after different timing of a bolus dose. RESULTS: The glucose levels for 3 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered 15 min or immediately before the meal, rather than after the meal. However, these differences were not statistically significant, except at the 1-h postprandial time point: bolus just after meal, 177 +/- 71 mg/dL (9.83 +/- 3.94 mmol/L); 15 min before meal, 136 +/- 52 mg/dL (7.55 +/- 2.89 mmol/L) (P = 0.044); and just before meal, 130 +/- 54 mg/dL (7.22 +/- 3.00 mmol/L) (P = 0.024). The area under the curve (AUC) (in mg/min) did not differ significantly with different bolus times, but the SD of the AUC was the lowest with the bolus given 15 min before the meal. CONCLUSIONS: These data support injection of the bolus before, rather than after, eating, even if the patient is hypoglycemic before meals.
RCT Entities:
BACKGROUND: Continuous subcutaneous insulin infusion is considered a safe and effective way to administer insulin in pediatric patients with type 1 diabetes, but achieving satisfactory and stable glycemic control is difficult. Several factors contribute to control, including fine-tuning the basal infusion rate and bolus timing. We evaluated the most effective timing of a pump-delivered, preprandial bolus in children with type 1 diabetes. METHODS: We assessed the response of 30 children with type 1 diabetes to a standard meal after different timing of a bolus dose. RESULTS: The glucose levels for 3 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered 15 min or immediately before the meal, rather than after the meal. However, these differences were not statistically significant, except at the 1-h postprandial time point: bolus just after meal, 177 +/- 71 mg/dL (9.83 +/- 3.94 mmol/L); 15 min before meal, 136 +/- 52 mg/dL (7.55 +/- 2.89 mmol/L) (P = 0.044); and just before meal, 130 +/- 54 mg/dL (7.22 +/- 3.00 mmol/L) (P = 0.024). The area under the curve (AUC) (in mg/min) did not differ significantly with different bolus times, but the SD of the AUC was the lowest with the bolus given 15 min before the meal. CONCLUSIONS: These data support injection of the bolus before, rather than after, eating, even if the patient is hypoglycemic before meals.
Authors: Karishma A Datye; Claire T Boyle; Jill Simmons; Daniel J Moore; Sarah S Jaser; Nicole Sheanon; Julie M Kittelsrud; Stephanie E Woerner; Kellee M Miller Journal: J Diabetes Sci Technol Date: 2017-09-12
Authors: Andrea E Scaramuzza; Dario Iafusco; Alessandra Bosetti; Alessandra De Palma; Gian Vincenzo Zuccotti Journal: Diabetes Care Date: 2011-02 Impact factor: 19.112
Authors: Megan Paterson; Kirstine J Bell; Susan M O'Connell; Carmel E Smart; Amir Shafat; Bruce King Journal: Curr Diab Rep Date: 2015-09 Impact factor: 4.810
Authors: Bruce W Bode; Joseph A Johnson; Liselotte Hyveled; Søren C Tamer; Marek Demissie Journal: Diabetes Technol Ther Date: 2017-01-05 Impact factor: 6.118
Authors: Prudence Lopez; Carmel Smart; Claire Morbey; Patrick McElduff; Megan Paterson; Bruce R King Journal: BMJ Open Diabetes Res Care Date: 2014-12-04