Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system

Susan M. Jones, Jill L. Quarry, Molly Caldwell-Mcmillan, David T. Mauger, Robert A. Gabbay

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. Research Design and Methods: Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS®, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. Results: Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (single-wave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. Conclusions: Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.

Original languageEnglish (US)
Pages (from-to)233-240
Number of pages8
JournalDiabetes Technology and Therapeutics
Volume7
Issue number2
DOIs
StatePublished - Apr 1 2005

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Meals
Insulin
Glucose
Hypoglycemia
Insulin Lispro
Postprandial Period
Type 1 Diabetes Mellitus
Hyperglycemia
Blood Glucose
Research Design
Incidence

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

Cite this

Jones, Susan M. ; Quarry, Jill L. ; Caldwell-Mcmillan, Molly ; Mauger, David T. ; Gabbay, Robert A. / Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. In: Diabetes Technology and Therapeutics. 2005 ; Vol. 7, No. 2. pp. 233-240.
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abstract = "Background: We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. Research Design and Methods: Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS{\circledR}, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100{\%} of insulin given immediately); (b) 4-h dual-wave bolus (50{\%} of insulin given immediately and 50{\%} given over a 4-h period); and (c) 8-h dual-wave bolus (50{\%} of insulin given immediately and 50{\%} given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. Results: Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (single-wave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. Conclusions: Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.",
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Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. / Jones, Susan M.; Quarry, Jill L.; Caldwell-Mcmillan, Molly; Mauger, David T.; Gabbay, Robert A.

In: Diabetes Technology and Therapeutics, Vol. 7, No. 2, 01.04.2005, p. 233-240.

Research output: Contribution to journalArticle

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T1 - Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system

AU - Jones, Susan M.

AU - Quarry, Jill L.

AU - Caldwell-Mcmillan, Molly

AU - Mauger, David T.

AU - Gabbay, Robert A.

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N2 - Background: We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. Research Design and Methods: Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS®, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. Results: Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (single-wave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. Conclusions: Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.

AB - Background: We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal. Research Design and Methods: Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS®, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza meal. Results: Divergence in blood glucose among the regimens was greatest at 8-12 h. The 8-h dual-wave bolus provided the best glycemic control and lowest mean glucose values (single-wave bolus, 133 mg/dL; 4-h dual-wave bolus, 145 mg/dL; 8-h dual-wave bolus, 104 mg/dL), leading to a difference in mean glucose of 29 mg/dL for the single-wave bolus versus the 8-h dual-wave bolus and 42 mg/dL for the 4-h dual-wave bolus versus the 8-h dual-wave bolus. The lower mean glucose in the 8-h dual-wave bolus was not associated with any increased incidence of hypoglycemia. Conclusions: Use of a dual-wave bolus extended over an 8-h period following a pizza meal provided significantly less postprandial hyperglycemia in the late postprandial period (8-12 h) with no increased risk of hypoglycemia.

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