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Post-prandial glucose levels following three methods of insulin bolusing: A study in adolescent girls and in comparison with girls without diabetes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Vårdforskning Medicin)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Vårdforskning Medicin)
Karolinska Institutet.
2009 (English)In: Practical diabetes international, ISSN 1357-8170, Vol. 26, no 3, 110-115 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to assess whether one method of insulin bolusing wassuperior to two others in managing two pasta meals, and to compare the glucose levelswith those of females without diabetes.Fifteen continuous subcutaneous insulin infusion (CSII)-treated adolescent femalesand 10 adolescent females without diabetes consumed two pasta meals with different fatcontents. The plasma glucose (p-glucose) values were followed using capillarymeasurement and continuous glucose monitoring (CGMS) until three hours after themeal. The CSII-treated females received the same insulin dose at every occasion as:(1) normal bolus; (2) dual-wave bolus – 60% of the dose as normal bolus and 40% overone hour; and (3) square-wave bolus – a prolonged dose over one hour.No differences were found in p-glucose peak or AUC between the bolus methodsafter either of the meals. There was a difference in p-glucose increase at one time pointafter the less fat meal; after 60 minutes the increase was greater with a square-wavebolus (Friedman’s test p<0.02). Forty-eight percent of the measurements among thediabetes adolescents showed post-prandial p-glucose levels ≤10mmol/L. Femaleswithout diabetes had earlier and lower p-glucose peak and smaller AUC.It was concluded that there were no overall differences in p-glucose excursionsbetween different methods of bolusing for these adolescent females after these meals. Asquare-wave bolus may be less favourable with a less fatty pasta meal, giving a higherp-glucose increase. It was possible to achieve normoglycaemic post-prandial p-glucoselevels among adolescents with diabetes.

Place, publisher, year, edition, pages
2009. Vol. 26, no 3, 110-115 p.
Keyword [en]
type 1 diabetes mellitus, adolescents, insulin infusion systems, post-prandial glucose, bolus insulin
National Category
Nursing Endocrinology and Diabetes
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-122723DOI: 10.1002/pdi.1350OAI: oai:DiVA.org:uu-122723DiVA: diva2:310875
Available from: 2010-04-16 Created: 2010-04-16 Last updated: 2010-05-27Bibliographically approved
In thesis
1. Self-management of diabetes in adolescents using insulin pumps
Open this publication in new window or tab >>Self-management of diabetes in adolescents using insulin pumps
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Insulin pump treatment (CSII) is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. However, despite the use of CSII, achieving the recommended disease control is difficult for adolescents.

The aim of this thesis was to explore aspects of self-management of diabetes in adolescents using insulin pumps in order to describe conditions contributing to the recommended disease control.

Three methods of bolusing (normal, dual-wave and square-wave) in connection with pasta meals were tested in a crossover study among 15 adolescents with diabetes to assess whether one method was superior in managing glucose levels. A cross-sectional study among 90 adolescents being treated with CSII was conducted to investigate the management of CSII, including the administration of bolus doses. Two qualitative interview studies, based on the grounded theory method, were performed to gain insight into the processes involved in taking bolus doses and to investigate reasons for missed bolus doses and strategies for avoiding missing them. Twelve adolescents, four parents and one diabetes specialist nurse were interviewed.

No method of bolusing was found to be superior in managing the glucose levels after these meals. The post-prandial glucose peaks were <10 mmol/L, in 48% of the cases, regardless of bolus methods. This indicates that adolescents can be encouraged to individually test which bolus method gives them the most normal post-prandial glucose levels.

The cross-sectional study showed that adolescents were satisfied with CSII, but that 38% had missed more than 15% of the bolus doses the day under study. The frequency of bolus doses correlated with the disease control.

Findings from the interview study revealed the need to clarify the responsibility for diabetes self-management in continuous negotiation between adolescents and parents to avoid insulin omission. The main reason for missed boluses was lost focus, and the strategies for remembering them were agreements involving reminders.

The thesis describes that individual dose testing, clarification of responsibility and agreements involving reminders are conditions contributing to the recommended disease control. The thesis also describes that lost focus and a lack of responsibility can lead to insulin omission and be a hindrance to achieving disease control.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 82 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 561
Keyword
Type 1 diabetes, Insulin infusion systems, Insulin omission, Adolescents, Adolescent parenting, Nursing, Qualitative research, Interviews
National Category
Nursing Endocrinology and Diabetes Pediatrics
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-122952 (URN)978-91-554-7811-7 (ISBN)
Public defence
2010-06-09, Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Note
Anna Kernell avled maj 2010.Available from: 2010-05-19 Created: 2010-04-21 Last updated: 2010-05-26Bibliographically approved

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