Missed Insulin Boluses for Snacks in Youth with Type 1 Diabetes

  1. Brandon W. VanderWel, BA,
  2. Laurel H. Messer, MPH, RN, CDE,
  3. Lauren A. Horton, BA,
  4. Bryan McNair, BA,
  5. Erin C. Cobry, BS,
  6. Kim K. McFann, PhD and
  7. H. Peter Chase, MD ({at}
  1. University of Colorado


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.


    • Received October 5, 2009.
    • Accepted December 17, 2009.