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May 4, 2005
Optimal Insulin Pump Dosing and Postprandial Glycemia Following a Pizza Meal Using the Continuous Glucose Monitoring System
The "pizza" study was published in the April issue of Diabetes Technology & Therapeutics and is the first clinical examination of the optimal timing of the dual-wave administration of insulin... I'm sure recruitment was not a problem. The general conclusions are presented simply:
"Keeping glucose levels from jumping too high or dipping too low may help to reduce the risk of cardiovascular disease, which has been connected to erratic glucose levels in those with diabetes," said Robert Gabbay, M.D., Ph.D., associate professor of medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, and co-director, Penn State Diabetes Center. "Our study shows that after a high carbohydrate, high fat meal like the pizza used in this study, spacing out insulin given by an insulin pump in two doses, one of which is over an eight-hour period, may keep glucose levels in a more favorable range than a single dose of insulin or a double dose taken over a shorter period."
From the National Library of Medicine:
Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system.
Jones SM, Quarry JL, Caldwell-McMillan M, Mauger DT, Gabbay RA.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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 (singlewave 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.
Posted by Diabetologica at May 4, 2005 12:03 AM