title: Ambulatory 24-hour fast using flexible insulin therapy in patients with type 1 diabetes.
abstract: OBJECTIVE
  Prolonged fasting may be necessary in life for religious, medical and other reasons. For this reason, our study investigated the feasibility and safety of a 24-h fast conducted at home for patients with type 1 diabetes.
  
  
  METHODS
  Thirty-four patients with type 1 diabetes performed a 24-h complete fast at home. Thirteen patients were treated with multiple insulin injections using either glargine (n=12) or NPH (n=1) as basal insulin. The remaining patients were treated with an insulin pump. All patients received their basal insulin only, which was adjusted to 40% of their total daily dose, and were monitored by either a Gold(®) or Guardian(®) continuous glucose monitoring (CGMS) device. Capillary glucose (SMBG) was targeted at 3.9-7.8 mmol/L, with a standardized protocol for correction of hyper- and hypoglycaemia. Interstitial glucose (IG) profiles were compared with the SMBG values; the IG profiles of patients using glargine or a pump and either of the two CGMS devices were also compared.
  
  
  RESULTS
  All of the patients completed the 24-h fast with no major incident. At the end of the fast, 80% of the IG values were on target. The route by which insulin was delivered made no difference, but there were more IG values on target in patients monitored by the Guardian(®) device. IG was below target in 104 occurrences and above-target in 34. After a mean intake of 10 g of sucrose, below-target IG was corrected within 30 min [range: 15-40]. The mean insulin dose to correct above-target episodes was 1 U.
  
  
  CONCLUSIONS
  Prolonged fasting is possible at home in patients with type 1 diabetes, provided the basal dose is adjusted. The use of CGMS is not necessary, but offers useful information on the patient's IG profile during the fast.
authors.affiliation: Service de diabétologie, Hôtel-Dieu, AP-HP, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Vigeral
authors.forename: A
authors.initials: A
authors.lastname: Sola-Gazagnes
authors.forename: S
authors.initials: S
authors.lastname: Nejjar
authors.forename: J
authors.initials: J
authors.lastname: M'Bemba
authors.forename: C
authors.initials: C
authors.lastname: Boitard
authors.forename: G
authors.initials: G
authors.lastname: Slama
authors.forename: F
authors.initials: F
authors.lastname: Elgrably
authors.forename: E
authors.initials: E
authors.lastname: Larger
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005215:Fasting / Q000097:blood*; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000097:blood / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000097:blood / Q000627:therapeutic use; D008297:Male; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine