Objective: Conventional bolus calculators apply negative prandial insulin corrections when pre-meal glucose levels are low. The present study examined the need for this negative correction with the artificial pancreas (AP).
Methods: Data were retrospectively analysed from a study conducted in a camp for children with type 1 diabetes. Meal boluses with negative corrections (n=98) of 47 participants (between 8-22 years old) using the McGill AP for 11 days were examined. The duration of insulin suspension before each meal and the insulin-on-board (IOB) at mealtime were calculated. The effects of these factors on postprandial hyperglycemia were analysed.
Results: The rate of postprandial hyperglycemia was 28% (18/65) for meals preceded by basal insulin suspensions <70 minutes, and 52% (17/33) for meals preceded by suspensions ≥70 minutes (p=0.02). The rate of postprandial hyperglycemia following suspensions ≥70 minutes compared to <70 minutes was significantly higher only if there was no IOB (64% [9/14] vs. 29% [13/45]; p=0.01). Meal size and total daily insulin dose did not influence these results.
Conclusion: Negative corrections with meal boluses may not be necessary following long insulin suspensions in the absence of IOB.
S. Major: None. A. El Fathi: None. E. Palisaitis: None. R.E. Kearney: None. J.E. von Oettingen: None. L. Legault: Advisory Panel; Self; Dexcom, Inc., Lilly Diabetes. Research Support; Self; AstraZeneca K.K., Merck & Co., Inc., Sanofi-Aventis. Other Relationship; Self; Lilly Diabetes. A. Haidar: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Eli Lilly and Company.
Canadian Institutes of Health Research (356406)