Optimizing the combination insulin bolus split for a high‐fat, high‐protein meal in children and adolescents using insulin pump therapy

Lopez, P. E.; Smart, Carmel E.; McElduff, Patrick; Foskett, Deborah C.; Price, D A; Paterson, Megan; King, Bruce R.

doi:10.1111/dme.13392

Cited by 28 publications

(73 citation statements)

References 12 publications

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“…Bell et al showed that 65% more insulin was required with HFHP meals and that a 30%/70% split over 2.4 hours was the optimal insulin delivery pattern . Lopez et al tested different bolus strategies for HFHP meals in children and young adults with T1D and came to the same conclusion; the combination bolus 30%/70% split best maintained glucose control in the late postprandial period . However, they suggested that the total insulin bolus should be increased to allow administration of 60% of the calculated bolus initially and an additional 70% in the extended bolus .…”

Section: Discussionmentioning

confidence: 99%

“…10 Lopez et al tested different bolus strategies for HFHP meals in children and young adults with T1D and came to the same conclusion; the combination bolus 30%/70% split best maintained glucose control in the late postprandial period. 11 However, they suggested that the total insulin bolus should be increased to allow administration of 60% of the calculated bolus initially and an additional 70% in the extended bolus. 11 Additional long-term studies are needed to examine the efficacy and the applicability of these strategies.…”

Section: Statistical Analysesmentioning

confidence: 99%

See 1 more Smart Citation

Impact of macronutrient content of meals on postprandial glucose control in the context of closed‐loop insulin delivery: A randomized cross‐over study

Gingras

Bonato

Messier

et al. 2018

Diabetes Obesity Metabolism

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The aim of this randomized four-way cross-over study was to examine the effect of added protein and/or fat in standard meals with a fixed carbohydrate content on postprandial glucose control with closed-loop insulin delivery in adults with type 1 diabetes. Participants (n = 15) consumed breakfast meals with a fixed carbohydrate content (75 ± 1 g) and added protein and/or fat (35 ± 2 g): (1) carbohydrate-only (standard), (2) high protein (HP), (3) high fat (HF) and (4) high fat + protein (HFHP). The closed-loop insulin delivery algorithm generated insulin bolus and infusion rates. The addition of fat, protein or both did not impact 5-hour post-meal sensor glucose area under the curve (AUC) (main outcome), mean sensor glucose or glycaemic peak as compared with a standard meal (P > 0.05). However, time to glycaemic peak was delayed by 40 minutes (P = 0.03) and 5-hour post-meal basal insulin requirements were 39% higher (P = 0.04) with an HFHP meal compared with a standard meal. In conclusion, in the context of closed-loop insulin delivery, protein and/or fat meal content affects the timing of postprandial glycaemic peak, insulin requirements and late glycaemic excursion, without impacting overall 5-hour AUC.

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Section: Discussionmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Impact of macronutrient content of meals on postprandial glucose control in the context of closed‐loop insulin delivery: A randomized cross‐over study

Gingras

Bonato

Messier

et al. 2018

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…In the present study insulin was delivered as a combination bolus for each algorithm. Combination insulin boluses have been shown to be beneficial for high fat and protein meals (3,4,(16)(17)(18)(19). However, the optimal split and duration of the combination bolus have not yet been determined.…”

Section: Discussionmentioning

confidence: 99%

A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with Type 1 diabetes

et al. 2018

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“…A good understanding of meal content and the glycaemic index is probably important for pump users to fully benefit from the effect of faster aspart. Although the use of faster aspart in the context of high‐ or low‐glycaemic index meals has not been addressed in clinical trials, there may be a need for different bolus types, such as a delayed/extended bolus with larger meals or a dual‐ or multi‐wave bolus for high‐fat and high‐protein meals (Figure ) . As a starting point for high‐fat and high‐protein meals, 30% of the total insulin dose can be administered immediately and 70% administered with a delay over the 2–4 hours following the meal.…”

Section: Faster Aspart Via Csii: Practical Considerationsmentioning

confidence: 99%

“…As a starting point for high‐fat and high‐protein meals, 30% of the total insulin dose can be administered immediately and 70% administered with a delay over the 2–4 hours following the meal. It should also be noted that more insulin than that calculated by carbohydrate counting alone may be needed …”

Section: Faster Aspart Via Csii: Practical Considerationsmentioning

confidence: 99%

Use of fast‐acting insulin aspart in insulin pump therapy in clinical practice

Evans

Ceriello

Danne

et al. 2019

Diabetes Obesity Metabolism

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Fast‐acting insulin aspart (faster aspart) is a novel formulation of insulin aspart (IAsp) containing the additional excipients niacinamide and L‐arginine. The improved pharmacological profile and greater early glucose‐lowering action of faster aspart compared with IAsp suggests that faster aspart may be advantageous for people with diabetes using continuous subcutaneous insulin infusion (CSII). The recent onset 5 trial was the first to evaluate the efficacy and safety of an ultra‐fast‐acting insulin in CSII therapy in a large number of participants with type 1 diabetes (T1D). Non‐inferiority of faster aspart to IAsp in terms of change from baseline in HbA1c was confirmed, with an estimated treatment difference (ETD) of 0.09% (95% CI, 0.01; 0.17; P < 0.001 for non‐inferiority [0.4% margin]). Faster aspart was superior to IAsp in terms of change from baseline in 1‐hour post‐prandial glucose (PPG) increment after a meal test (ETD [95% CI], −0.91 mmol/L [−1.43; −0.39]; P = 0.001), with statistically significant improvements also at 30 minutes and 2 hours. The overall rate of severe or blood glucose‐confirmed hypoglycaemia was not statistically significantly different between treatments, with an estimated rate ratio of 1.00 (95% CI, 0.85; 1.16). A numerical imbalance in severe hypoglycaemic episodes between faster aspart and IAsp was seen in the treatment (21 vs 7) and the 4‐week run‐in periods (4 vs 0). Experience from clinical practice indicates that all pump settings should be reviewed when initiating faster aspart with CSII, and that the use of continuous glucose monitoring or flash glucose monitoring, along with a good understanding of meal content and bolus type, may also facilitate optimal use. This review summarizes the available clinical evidence for faster aspart administered via CSII and highlights practical considerations based on clinical experience that may help healthcare providers and individuals with T1D successfully initiate and adjust faster aspart with CSII.

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Optimizing the combination insulin bolus split for a high‐fat, high‐protein meal in children and adolescents using insulin pump therapy

Cited by 28 publications

References 12 publications

Impact of macronutrient content of meals on postprandial glucose control in the context of closed‐loop insulin delivery: A randomized cross‐over study

Impact of macronutrient content of meals on postprandial glucose control in the context of closed‐loop insulin delivery: A randomized cross‐over study

A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with Type 1 diabetes

Use of fast‐acting insulin aspart in insulin pump therapy in clinical practice

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