Safety of New Algorithms for Premeal Insulin Boluses in High Glycaemic Index Meals in Persons With Type 1 Diabetes Mellitus Using Insulin Pumps

Abstract

Aims: Consumption of glucose or foodstuff s with high glycaemic index (GI) in persons with type 1 diabetes mellitus (PWD1) is a hot topic in present diabetology. The aim of our pilot prospective study was to assess the effi ciency of empirically suggested simple algorithms for premeal boluses in PWD1 using insulin pumps and continuous glucose monitoring (CGM).Methods: Six PWD1 (aged 46.2±15.09 y, diabetes duration 14.5±9.65 y, HbA1c/IFCC 6.3±1.59%, BMI 23.6±1.67 kg/m 2 , mean±SD) on insulin pumps Paradigm 522/722 with RT-CGMS sensors (Medtronic MiniMed, Northridge, CA) underwent a 12-week CGM. In one week, subjects consumed 50g of carbohydrates in eleven alternative meals (rice squares, dark chocolate, white bread, honey, glucose, ravioli with meat and Eidam cheese, mashed potatoes with fi sh fi ngers, apricot dumplings with butter, spa waffl es, spalta squares, and tomato soup with pasta) eaten for breakfasts, lunches, snacks and dinners in order to calculate their GI. The insulin boluses were adjusted according to empirically defi ned algorithms. Average glucose levels and daily insulin doses over three one-week periods (before testing, testing and after testing) were compared.Results: During the observational period, the weekly averages of glucose levels (9.1±2.33 mmol/l vs. 9.2±2.30 mmol/l vs. 9.0±2.43 mmol/l, respectively) and daily insulin doses (39.1± 8.14 IU/d vs. 39.7±10.7 IU/d vs. 38.6±9.97 IU/d, respectively) were similar. One-week consumption of high GI foodstuff s had only a negligeable eff ect on average glucose levels. Conclusion:The suggested algorithms for premeal insulin boluses appear to limit the risk of potential hyperglycaemia resulting from intake of high GI foodstuff s.

Improving the Estimation of Meal-Time Insulin Dose Based On the Glycaemic Load of a Meal in Children with Type 1 Diabetes on Insulin Pump Therapy: A Randomized Study

“…In an analysis by Lippaiova et al [16], the mean weekly glycaemia measured by CGMS before, during and after a high load meal did not differ, but the mean glucose level did not reflect changes which appear after the meal.…”

Extended Prandial Glycemic Profiles of Foods as Assessed Using Continuous Glucose Monitoring Enhance the Power of the 120-Minute Glycemic Index

“…44 Predicting postprandial glycemia is also useful for improving algorithms for premeal insulin boluses for persons with type 1 diabetes. 6,45 However, the paradigm for recommending food with low/high GI under various conditions is complex [46][47][48][49] and remains both a controversial 50,51 and a challenging entity. 52,53 The 120-minute glycemic index values fail to fully account for the changes in glycemia that occur after ingestion of a mixed meal because glycemia remains significantly above baseline for longer than 120 minutes.…”

Occurence of Adverse Events Due to Continuous Glucose Monitoring

“…The question arises whether these results may be generalized for persons with diabetes. To date, the transcutaneous sensor of the CGMS was used for 9 days or even longer to control the eff ectiveness of CSII in persons with type 1 diabetes 24 or to determine the glycaemic index of various foods 25,26 . No serious adverse events were seen which is compatible with the observations of other groups 5,6 .…”