The optimal type of bolus following a “Mediterranean” meal in children and adolescents with type 1 diabetes (T1DM) using insulin pump therapy (CSII)

Objectives: Last year we observed that the best bolus for a pizza margherita meal is 30/70 dual wave bolus (DWB) extended over 6 hours. Because of this, we start to consider that for a “Mediterranean” meal (MM) a DWB might be better than a simple bolus (SB). We compare a SB with different kind of DWB in order to identify the optimal one in case of a MM. Methods: We evaluated 26 children, aged 5-23 years (mean 15.4 ± 4.8 years) with T1DM from 9.7 ± 4.9 years, BMI 22.0 ± 4.4 kg/m2, with CSII (insulin requirement 0.76 ± 0.14 U/kg/day). Each patient utilized the following 6 aspart regimens on 3 consecutive days, and glucose values were recorded with SMBG: a) a SB (100% of insulin (I) given immediately) injected 15 min before meal; b) a SB (100% of I given immediately) injected just before meal; c) 4-hour DWB (50% of I given immediately and 50% given over a 4-hour period) injected 15 min prior meal; d) 4-hour DWB (50% of I give immediately and 50% given over a 4-hour period) injected just before meal; e) 4-hour DWB (70% given immediately and 30% given over a 4-hour period) injected 15 min before meal; and f) 4-hour DWB (70% given immediately and 30% given over a 4-hour period) injected just before meal. Total CHO was kept constant for each meal; I dose was calculated according to glycaemic value and CHO, using ISF and INS : CHO ratio, personalized for each patient. Results: Conclusion: 70/30 DWB extended over 4-hour period following a MM injected 15 minutes before provided significantly less postprandial hyperglycemia during the 4-hour period. SB could be used only if given 15 minutes before meal, even if we observed a rise in glycaemic values in the last 2 hours of the study.