Effect of Age of Infusion Site and Type of Rapid-Acting Analog on Pharmacodynamic Parameters of Insulin Boluses in Youth with TIDM on Insulin Pump Therapy
- Karena L Swan, M.D. (karena.swan{at}yale.edu)1,
- James D Dziura, PhD.2,
- Garry M Steil, PhD.4,
- Gayane R Voskanyan, PhD.3,
- Kristin A Sikes, MSN, APRN1,
- Amy T Steffen1,
- Melody L Martin1,
- William V Tamborlane, M.D.1,2 and
- Stuart A Weinzimer, M.D.1
- 1Department of Pediatrics, Section of Pediatric Endocrinology, Yale University, 333 Cedar Street, P.O. Box 208064, New Haven, CT, 06520 Ph: 203-764-9199, Fax: 203-737-2829
- 2 Yale Center for Clinical Investigation, Yale University School of Medicine, Suite 114, 2 Church Street South, New Haven, CT, 06519, Ph: 203-785-3482, Fax: 203-737-2480
- 3Medtronic MiniMed, 18000 Devonshire Street, Northridge, CA, 91325-1219 Ph: 818-576-4330, Fax: 818-576-6206
- 4 Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115 Ph: 617-355-7504, Fax: 617-344-2565
Abstract
Objective To examine the effect of type of insulin analog and age of insertion site on the pharmacodynamic (PD) characteristics of a standard insulin bolus in youth with type 1 diabetes (T1DM) on insulin pump therapy.
Research Design and Methods 17 insulin pump-treated adolescents with T1DM underwent two euglycemic clamp procedures following a 0.2 unit/kg bolus of either insulin aspart or lispro on day 1 and day 4 of insulin pump site insertion. Glucose infusion rates (GIR) required to maintain euglycemia was the primary PD measure.
Results There were no statistically significant differences in any of the PD parameters between aspart and lispro during Day 1 and Day 4. However, when the two groups were combined, TmaxGIR, time to discontinuation of exogenous glucose infusion and time to half-maximal onset and offset of insulin action (Ti50, and Td50) were observed significantly earlier during Day 4 compared to Day 1(p=0.03−0.0004), but the overall area under the GIR curve was similar on Day 1 and day 4.
Conclusions With both insulin aspart and lispro, there is earlier peak and shorter duration of action with increasing duration of infusion site use, but overall insulin action is not affected.
Footnotes
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- Received March 24, 2008.
- Accepted November 7, 2008.
- Copyright © 2008 American Diabetes Association
