Premeal injection of rapid-acting insulin reduces postprandial glycemic excursions in type 1 diabetes

  1. J. Hans DeVries, PhD
  1. Academic Medical Centre, Department of Internal Medicine, Amsterdam, the Netherlands

Abstract

Objective: To assess the effect of three premeal timings of rapid-acting insulin on postprandial glucose excursions in type 1 diabetes.

Research design and methods: 10 subjects participated in a three-way randomized cross-over trial. Mean (± SD) age was 45.5 ± 12.09 years, HbA1c 8.55 ± 1.50%, duration of diabetes 23.8 ± 7.81 years and duration of CSII therapy 8.5 ± 6.10 years. Insulin aspart was administered at 30, 15 or 0 minutes before mealtime.

Results: Area under the curve was lower in the −15 stratum (0.41 ± 0.51 mmol/L/min) compared to the −30 stratum (1.89 ± 0.72 mmol/L/min, P = 0.029) and 0 stratum (2.11 ± 0.66 mmol/L/min, P = 0.030). Maximum glucose excursion was lower in the −15 stratum (4.77 ± 0.52 mmol/L) compared to the −30 (6.48 ± 0.76 mmol/L, P = 0.025) and 0 stratum (6.93 ± 0.76 mmol/L, P = 0.022). Peak glucose level was lower in the −15 stratum (9.26 ± 0.72 mmol/L) compared to the −30 stratum (11.74 ± 0.80 mmol/L, P = 0.007) and the 0 stratum (12.29 ± 0.93, P=0.009). Time spent in the 3.5-10 mmol/L range was higher in the −15 stratum (224.5 ± 25.0 min), compared to the 0 stratum (90.5 ± 23.2 min, P=0.001). There was no significant difference in occurrence of glucose levels <3.5mmol/L between strata (P=0.901).

Conclusions: Administration of rapid-acting insulin analogues 15 minutes before mealtime results in lower postprandial glucose excursions and more time spent in the 3.5–10.0 mmol/L range, without increased risk of hypoglycemia.

Footnotes

    This Article

    1. Diabetes Care
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