Missed Insulin Boluses for Snacks in Youth With Type 1 Diabetes

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 Δ 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), Δ 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.Previous studies have demonstrated the deleterious effect of missed insulin doses for meals (1–4). None, however, have examined the effect of missed insulin boluses for snacks. Because youth frequently snack when unsupervised, it is likely that missed insulin boluses are even more common for snacks than for meals. The purpose of this investigation was to use data from continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) together to evaluate the glycemic profiles of missed insulin boluses for afternoon snacks.