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J Diabetes Investig. 2019 Feb 15. doi: 10.1111/jdi.13027. [Epub ahead of print]

Assessment of optimal insulin administration timing for standard carbohydrates rich meals using continuous glucose monitoring in children with type 1 diabetes-crossover randomized study.

Author information

1
Neonatal Intensive Care and Pathology of Newborn Unit. Upper, Silesian Center for Child's Health, Katowice, Poland.
2
Pediatrics Clinic, The Upper-Silesian Child Health Care, Katowice, Poland.
3
Gynaecology and Obstetrics Unit with Oncological Gyneacology Subunit Center of Oncology in Katowice, Poland.
4
Department of Children's Diabetology, Medical University Of Silesia, Katowice, Poland.

Abstract

OBJECTIVE:

Assessment of postprandial glucose concentration after carbohydrates rich meals using continuous glucose monitoring in 30 children with type 1 diabetes treated using continuous subcutaneous insulin infusion with a rapid-acting analogs insulin.

METHODS:

During 3 days, participants administering simple boluses with different delay time between insulin administration and beginning of carbohydrates rich meals consumption (meal №1 containing - 197 kcal, №2 - 247 kcal and meal №3 - 323 kcal; practically not containing protein and fat). In our cross-over randomized study we analyzed: average glucose concentration profiles in 5-minutes intervals, mean glucose at insulin administration, after 120 and 180 minutes, mean and peak glucose, glucose peak time, areas under glucose and glucose increase curves, time period lengths with glucose below 50, 70 mg/dl and over 140, 200 mg/dl.

RESULTS:

For test meals at 20-minutes versus 0-minute delay time, the study exposed a longer median time period to reach top glucose (95 vs 65 min, p=0,01) after meals. A tendency to the lowest peak and mean glucose, and the longest time with glucose within a normal range was observed in patients who administered bolus insulin 20 minutes before meal.

CONCLUSIONS:

For carbohydrates rich meals, administration of a proper dose of a rapid acting insulin analog is crucial. Influence of rapid-acting analogs insulin administration timing seems to be of minor importance in comparison to correct insulin dose adjustment, however a tendency to achieve more balanced glucose profiles was found in a group who administered insulin 20 minutes before meal. This article is protected by copyright. All rights reserved.

KEYWORDS:

Diabetes type 1; bolus doses; rapid-acting analog insulin

PMID:
30768859
DOI:
10.1111/jdi.13027
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