Post‐prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetes

Aims To determine if one method of short‐acting insulin bolus administration is superior to other methods in managing a meal high in carbohydrates, calories and fat. Methods Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog®) agreed to consume the same meal high in carbohydrates, calories and fat on four occasions 1 week apart. They received the same dose of bolus insulin on each of the four occasions randomly assigned and beginning 10 min prior to the meal as either a single bolus, two separate boluses of one‐half the same total dose (the second after 90 min), the entire bolus given as a square‐wave (over 2 h) or a dual‐wave (70% as a bolus and 30% as a square‐wave over 2 h). Blood glucose levels were measured at –60 and –30 min and at zero time, and then every half‐hour for 6 h using the Hemacue® in the out‐patient clinic. Results Changes in blood glucose values from fasting were the lowest after 90 and 120 min ( P  < 0.01) when the dual wave was administered. When the dual or square‐wave methods of insulin administration were used, subjects had significantly lower glucose levels after 4 h in comparison with when the single or double boluses were used ( P  = 0.04). Conclusions We conclude that the dual wave provided the most effective method of insulin administration for this meal. The dual‐ and square‐wave therapies resulted in lower glucose levels 4 h after the meal in comparison with the single and double‐bolus treatments.