scholarly journals Carbohydrate Requirements for Prolonged, Fasted Exercise with and without Basal Rate Reductions in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII)

2020 ◽  
Author(s):  
Sarah M McGaugh ◽  
Dessi P Zaharieva ◽  
Rubin Pooni ◽  
Ninoschka C D’Souza ◽  
Todd Vienneau ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Infusion ◽  
Fat Oxidation ◽  
Rate Reduction ◽  
Basal Rate ◽  
Carbohydrate Feeding ◽  
Exercise Onset ◽  
Design And Methods ◽  
Better Than

<b>Objective:</b> Exercising while fasted in type 1 diabetes facilitates weight loss, however the best strategy to maintain glucose stability remains unclear. <p><b>Research Design and Methods:</b> Fifteen adults on CSII completed three sessions of fasted walking (120min at 45%VO<sub>2peak</sub>) in a randomized crossover design: 50% basal rate reduction set 90min pre-exercise (-90<sub>min</sub>50%<sub>BRR</sub>); usual basal rate with carbohydrate intake (0.3g/kg/hr; CHO-only); and combined 50%<sub> </sub>basal rate reduction set at exercise onset with carbohydrate (0.3g/kg/hr; Combo). </p> <p><b>Results:</b> Combo had a smaller change in glucose (5±47mg/dL) vs CHO-only (-49±61mg/dL, <i>P</i>=0.03) or -90<sub>min</sub>50%<sub>BRR</sub> (-34±45mg/dL). -90<sub>min</sub>50%<sub>BRR</sub> produced higher b-hydroxybutyrate levels (0.4±0.3 vs 0.1±0.1mmol/L) and greater fat oxidation (0.51±0.2 vs 0.39±0.1g/min) than CHO-only (both <i>P</i><0.05).</p> <b>Conclusions:</b> All strategies examined produced stable glycemia for fasted exercise, but a 50%<sub> </sub>basal rate reduction set 90 min pre-exercise eliminates carbohydrate needs and enhances fat oxidation better than carbohydrate feeding with or without a basal rate reduction set at exercise onset.

scholarly journals Carbohydrate Requirements for Prolonged, Fasted Exercise with and without Basal Rate Reductions in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII)

2020 ◽  
Author(s):  
Sarah M McGaugh ◽  
Dessi P Zaharieva ◽  
Rubin Pooni ◽  
Ninoschka C D’Souza ◽  
Todd Vienneau ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Infusion ◽  
Fat Oxidation ◽  
Rate Reduction ◽  
Basal Rate ◽  
Carbohydrate Feeding ◽  
Exercise Onset ◽  
Design And Methods ◽  
Better Than

<b>Objective:</b> Exercising while fasted in type 1 diabetes facilitates weight loss, however the best strategy to maintain glucose stability remains unclear. <p><b>Research Design and Methods:</b> Fifteen adults on CSII completed three sessions of fasted walking (120min at 45%VO<sub>2peak</sub>) in a randomized crossover design: 50% basal rate reduction set 90min pre-exercise (-90<sub>min</sub>50%<sub>BRR</sub>); usual basal rate with carbohydrate intake (0.3g/kg/hr; CHO-only); and combined 50%<sub> </sub>basal rate reduction set at exercise onset with carbohydrate (0.3g/kg/hr; Combo). </p> <p><b>Results:</b> Combo had a smaller change in glucose (5±47mg/dL) vs CHO-only (-49±61mg/dL, <i>P</i>=0.03) or -90<sub>min</sub>50%<sub>BRR</sub> (-34±45mg/dL). -90<sub>min</sub>50%<sub>BRR</sub> produced higher b-hydroxybutyrate levels (0.4±0.3 vs 0.1±0.1mmol/L) and greater fat oxidation (0.51±0.2 vs 0.39±0.1g/min) than CHO-only (both <i>P</i><0.05).</p> <b>Conclusions:</b> All strategies examined produced stable glycemia for fasted exercise, but a 50%<sub> </sub>basal rate reduction set 90 min pre-exercise eliminates carbohydrate needs and enhances fat oxidation better than carbohydrate feeding with or without a basal rate reduction set at exercise onset.

scholarly journals A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D)

2020 ◽  
pp. 193229682090619
Author(s):  
Siân Rilstone ◽  
Monika Reddy ◽  
Nick Oliver
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Total Daily Dose ◽  
Subcutaneous Insulin ◽  
Basal Rate ◽  
Absolute Change ◽  
Significant Difference

Background: Initiation of continuous subcutaneous insulin therapy (CSII) in type 1 diabetes requires conversion of a basal insulin dose into a continuous infusion regimen. There are limited data to guide the optimal insulin profile to rapidly achieve target glucose and minimize healthcare professional input. The aim of this pilot study was to compare circadian and flat insulin infusion rates in CSII naïve adults with type 1 diabetes. Methods: Adults with type 1 diabetes commencing CSII were recruited. Participants were randomized to circadian or flat basal profile calculated from the total daily dose. Basal rate testing was undertaken on days 7, 14 and 28 and basal rates were adjusted. The primary outcome was the between-group difference in absolute change in insulin basal rate over 24 hours following three rounds of basal testing. Secondary outcomes included the number of basal rate changes and the time blocks. Results: Seventeen participants (mean age 33.3 (SD 8.6) years) were recruited. There was no significant difference in absolute change in insulin basal rates between groups ( P = .85). The circadian group experienced significant variation in the number of changes made with the most changes in the morning and evening ( P = .005). The circadian group received a greater reduction in total insulin (−14.1 (interquartile range (IQR) −22.5-12.95) units) than the flat group (−7.48 (IQR −11.90-1.23) units) ( P = .021). Conclusion: The initial insulin profile does not impact on the magnitude of basal rate changes during optimization. The circadian profile requires changes at specific time points. Further development of the circadian profile may be the optimal strategy.

scholarly journals Patients with Type 1 Diabetes Treated with Insulin Pumps Need Widely Heterogeneous Basal Rate Profiles Ranging from Negligible to Pronounced Diurnal Variability

2020 ◽  
pp. 193229682094993
Author(s):  
Anna M. Lindmeyer ◽  
Juris J. Meier ◽  
Michael A. Nauck
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Basal Insulin ◽  
Insulin Infusion ◽  
Insulin Pump Therapy ◽  
Target Range ◽  
Lower Probability ◽  
Basal Rate ◽  
Dawn Phenomenon

Background: Pump-treated patients with type 1 diabetes have widely differing basal insulin infusion profiles. We analyzed consequences of such heterogeneity for glycemic control under fasting conditions. Methods: Data from 339 adult patients with type 1 diabetes on insulin pump therapy undergoing a 24-hour fast (basal rate test) were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations as well as their proportions within, below, or above arbitrarily defined target ranges were assessed for specific periods of the day (eg, 1-7 hours, “dawn” period, 16-19 hours, “dusk” period, reference period 20-1 hours/10-14 hours), by tertiles of a predefined “dawn” index (mean basal insulin infusion rate during the “dawn” divided by the reference periods). Results: The “dawn” index varied interindividually from 0.7 to 4.4. Basal insulin infusion profiles exhibited substantial differences ( P = .011), especially overnight. Despite higher insulin infusion rates at 4 and 6.45 hours, patients with the most pronounced “dawn” phenomenon exhibited higher plasma glucose concentrations at those time points ( P < .012). Patients with a marked “dawn” phenomenon exhibited a lower probability for low (<4.4 mmol/L) and a higher probability of high values (>7.2 mmol/L) during the dawn period (all P values <.01). Conclusions: We observe substantial interindividual heterogeneity in the “dawn” phenomenon. However, widely different empirically derived basal insulin infusion profiles appear appropriate for individual patients, as indicated by similar plasma glucose concentrations, mainly in the target range, during a 24-hour fasting period.

scholarly journals Continuous Subcutaneous Insulin Infusion and Its Characteristics in Young People with Type 1 Diabetes with Optimal Glucose Control (Preprint)

2018 ◽  
Author(s):  
Goran Petrovski ◽  
Marija Zivkovic
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Glucose Control ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Early Morning ◽  
Fine Tuning ◽  
Subcutaneous Insulin ◽  
Basal Rate

BACKGROUND Continuous subcutaneous insulin infusion (CSII) is established model for mimicking physiological insulin, which can overcome some of these barriers. CSII therapy is becoming more popular treatment modality in young people with T1D.Several studies have demonstrated the superiority of CSII over MDI therapy in T1D patients in terms of improved glucose control, the rate of hypoglycemia, dawn phenomenon and glucose variability OBJECTIVE To describe Continuous Subcutaneous Insulin Infusion (CSII) characteristics in young people with Type 1 Diabetes (T1D) with optimal glucose control and to describe possible simple CSII settings for fine tuning. METHODS This retrospective study was conducted at University Clinic of Endocrinology, Diabetes and Metabolic Disorders in Skopje. The study enrolled CSII patients with T1D (age 12-25 years) visited our center from January to December 2016. Patient characteristics were collected through the electronic medical record system and CSII characteristics were obtained from 8 weeks reports prior to Hba1c, generated by Carelink Therapy Management Software (Medtronic, Northridge, USA). RESULTS Ninety-three patients were grouped according age: 12-18 years and 19-25 years. More than 70% of patients achieved HbA1c <7.5% (<58 mmol/mol). Significant difference in basal insulin was found between two age groups. Patients aged 12-18 years had five basal segments, less basal rate in early morning (03-07h) and slight decrease of afternoon basal rate (13-19h), comparing with patients aged 19-25 years with four basal segments, more basal rate in early morning (03-07h) and no decrease of afternoon basal rate (13-19h). CONCLUSIONS Optimal glucose control is achievable in real life conditions among T1D patients on CSII therapy. Bolus wizard, frequent bolusing, multiple basal segments, and close follow up can be determinants for better control. Simple CSII settings as a tool, derived from our data may help clinicians to fine tune T1D patients and achieve optimal glucose control. CLINICALTRIAL EN16-12

scholarly journals Twenty-Four Hour Fasting (Basal Rate) Tests to Achieve Custom-Tailored, Hour-by-Hour Basal Insulin Infusion Rates in Patients With Type 1 Diabetes Using Insulin Pumps (CSII)

2019 ◽  
pp. 193229681988275
Author(s):  
Michael A. Nauck ◽  
Anna M. Lindmeyer ◽  
Chantal Mathieu ◽  
Juris J. Meier
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Basal Insulin ◽  
Insulin Infusion ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Target Range ◽  
Pump Therapy ◽  
Basal Rate

Background: Twenty-four hour fasting periods are being used to scrutinize basal insulin infusion rates for pump-treated patients with type 1 diabetes. Methods: Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy undergoing a 24-hour fast as a basal rate test were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations within, below, or above arbitrarily defined target ranges were assessed for periods of the day of special interest (eg, 01:00-07:00 am, “dawn” period, 04:00-07:00 pm, and “dusk” period). Statistics: χ2-tests, paired t-tests were used. Results: Basal rates (mean: 0.90 ± 0.02 IU/h) showed circadian variations with peaks corresponding to “dawn” (1.07 ± 0.02 IU/h from 01:00 to 07:00 am) and, less prominently, “dusk” (0.95 ± 0.02 IU/h from 03:00 to 07:00 pm). Individual mean plasma glucose concentrations averaged 6.6 ± 0.1 mmol/L, with 53.1% in the predefined “strict” (4.4-7.2 mmol/L) target range. Interestingly, during the “dawn” period, plasma glucose was significantly higher (by 0.5 ± 0.1 mmol/L [95% confidence interval: 0.3-0.8 mmol/L; P < .0001]) and the odds ratio for hypoglycemia was significantly lower compared to the reference period. Interpretation: Twenty-four hour fasting periods as basal rate tests frequently unravel periods with inappropriate basal insulin infusion rates potentially responsible for fasting hyper- or hypoglycemia. Notably, the higher basal insulin infusion rate found during the “dawn” period seems to be justified and may need to be accentuated.

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