title: Timing of bolus in children with type 1 diabetes using continuous subcutaneous insulin infusion (TiBoDi Study).
abstract: BACKGROUND
  Continuous subcutaneous insulin infusion is considered a safe and effective way to administer insulin in pediatric patients with type 1 diabetes, but achieving satisfactory and stable glycemic control is difficult. Several factors contribute to control, including fine-tuning the basal infusion rate and bolus timing. We evaluated the most effective timing of a pump-delivered, preprandial bolus in children with type 1 diabetes.
  
  
  METHODS
  We assessed the response of 30 children with type 1 diabetes to a standard meal after different timing of a bolus dose.
  
  
  RESULTS
  The glucose levels for 3 h after the meal were lower (i.e., closer to the therapeutic target of <140 mg/dL) when the bolus doses were administered 15 min or immediately before the meal, rather than after the meal. However, these differences were not statistically significant, except at the 1-h postprandial time point: bolus just after meal, 177 +/- 71 mg/dL (9.83 +/- 3.94 mmol/L); 15 min before meal, 136 +/- 52 mg/dL (7.55 +/- 2.89 mmol/L) (P = 0.044); and just before meal, 130 +/- 54 mg/dL (7.22 +/- 3.00 mmol/L) (P = 0.024). The area under the curve (AUC) (in mg/min) did not differ significantly with different bolus times, but the SD of the AUC was the lowest with the bolus given 15 min before the meal.
  
  
  CONCLUSIONS
  These data support injection of the bolus before, rather than after, eating, even if the patient is hypoglycemic before meals.
authors.affiliation: Department of Paediatrics, University of Milano, Ospedale Luigi Sacco, 20154 Milan, Italy. scaramuzza.andrea@hsacco.it
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Scaramuzza
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.forename: Laura
authors.initials: L
authors.lastname: Santoro
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bosetti
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Palma
authors.forename: Daniele
authors.initials: D
authors.lastname: Spiri
authors.forename: Chiara
authors.initials: C
authors.lastname: Mameli
authors.forename: Gian Vincenzo
authors.initials: GV
authors.lastname: Zuccotti
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin