title: Missed insulin boluses for snacks in youth with type 1 diabetes.
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 nine subjects were retrospectively evaluated. Glucose excursions between 1330 and 1700 h were defined as relating to snacks with insulin or snacks with no insulin administered. Area under the curve >180 mg/dl (AUC >180), average Delta glucose, and rate of change 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 per event; P < 0.001), Delta glucose (114 vs. 52 mg/dl; P < 0.001), and average rate of change (1.3 vs. 1.1 mg/dl per minute; P < 0.001). CONCLUSIONS This study shows that afternoon snacks without insulin boluses are common and result in significantly higher glucose excursions than snacks with insulin administration.
authors.affiliation: University of Colorado, Aurora, Colorado, USA.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Vanderwel
authors.forename: Laurel H
authors.initials: LH
authors.lastname: Messer
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Horton
authors.forename: Bryan
authors.initials: B
authors.lastname: McNair
authors.forename: Erin C
authors.initials: EC
authors.lastname: Cobry
authors.forename: Kim K
authors.initials: KK
authors.lastname: McFann
authors.forename: H Peter
authors.initials: HP
authors.lastname: Chase
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004435:Eating / Q000502:physiology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin