Abstract

Objective: To evaluate the effects of missed insulin boluses for snacks in youth with type 1 diabetes.

Research Design and Methods: Three months of simultaneous continuous subcutaneous insulin infusion and continuous glucose monitoring data from 9 subjects were retrospectively evaluated. Glucose excursions between 1330-1700 hrs were defined as relating to snacks with insulin or snacks with no insulin administered. Area under the curve >180 mg/dl (AUC>180), average Δ glucose and rate of change (ROC) were analyzed and compared within and between groups.

Results: A total of 94 snacks without insulin and 101 snacks with insulin were analyzed. Snacks without insulin had significantly higher log (AUC>180+1) (1.26 vs. 0.44 mg/dL•event; p<0.001), Δ glucose (114 vs. 52 mg/dL; p<0.001) and average ROC (1.3 vs. 1.1 mg/dL-min; p<0.001).

Conclusion: This study shows that afternoon snacks without insulin boluses are common and result in significantly higher glucose excursions compared to snacks with insulin administration.