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OBJECTIVE - The purpose of this study was to examine the effect of type of insulin analog and age of insertion site on the pharmacodynamic characteristics of a standard insulin bolus in youth with type 1 diabetes receiving insulin pump therapy.
RESEARCH DESIGN AND METHODS - Seventeen insulin pump-treated adolescents with type 1 diabetes underwent two euglycemic clamp procedures after a 0.2 unit/kg bolus of either insulin aspart or lispro on day 1 and day 4 of insulin pump site insertion. The glucose infusion rate (GIR) required to maintain euglycemia was the primary pharmacodynamic measure.
RESULTS - There were no statistically significant differences in any of the pharmacodynamic parameters between aspart and lispro during day 1 and day 4. However, when the two groups were combined, time to discontinuation of exogenous glucose infusion, and time to half-maximal onset and offset of insulin action were observed significantly earlier during day 4 compared with day 1 (P = 0.03-0.0004), but the overall area under the GIR curve was similar on day 1 and day 4.
CONCLUSIONS - With both insulin aspart and lispro, there is an earlier peak and shorter duration of action with increasing duration of infusion site use, but overall insulin action is not affected.
Diabetes Care 32:240-244, 2009
As a result of the Diabetes Control and Complications Trial and its fol- low-up Epidemiology of Diabetes Interventions and Complications study, current recommendations mandate that youth with type 1 diabetes should aim to achieve metabolic control as close to nor- mal as possible and as early in the course of the disease as possible. Although such strict treatment goals are particularly difficult to achieve in adolescents with type 1 diabetes (1-3), advances in insulin pump technology and the development of rapid-acting insulin analogs have provided clinicians who treat adolescents with type 1 diabetes with new management tools.
With continuous subcutaneous insulin infusion (CSII) pump therapy, bolus doses of rapid-acting insulin analogs provide better control of postprandial hyperglycemia without increasing the risk of hypoglycemia in comparison to what can be achieved with regular insulin (4-9). In addition, the newest insulin pumps account for residual insulin action in their bolus calculator software to prevent hypoglycemia related to multiple bolus doses given over a short interval. However, the...