Insulin delivery patterns required to maintain postprandial euglycemia in type 1 diabetes following consumption of traditional Egyptian Ramadan Iftar meal using insulin pump therapy: A randomized crossover trial.

Abstract

During Ramadan, traditional Egyptian Iftar meals have large amounts of high-glycemic index carbohydrate and fat. The efficacy of different bolus regimens on optimizing post prandial glucose (PPG) excursion following this Iftar meal was assessed. A randomized controlled trial evaluating 4-h PPG measured by continuous glucose-monitoring was conducted. A total of 25 youth with T1DM using insulin pumps were given the same Iftar meal (fat [45 g], protein [28 g], CHO [95 g]) on seven consecutive days. Insulin to carbohydrate ratio (ICR) was individualized, and all boluses were given upfront 20min before Iftar. Participants were randomized to receive a standard bolus and six different split boluses delivered over 4h in the following splits: dual wave (DW) 50/50; DW 50/50 with 20% increment (120% ICR); DW60/40; DW 60/40 with 20% increment; DW 70/30 and DW 70/30 with 20% increment. Standard bolus and split 70/30 with 20% increment resulted in significantly lower early glucose excursions (120min) with mean excursions of less than 40 mg/dL (2.2 mmol/L) compared to other conditions (p< 0.01). The split 70/30 with 20% increment significantly optimized late PPG excursion (240min) in comparison to standard bolus (p< 0.01), as well as resulting in a significantly lower post meal glucose area under the curve compared with all other conditions (p< 0.01), with no late hypoglycemia. To achieve physiologic PPG profile in traditional Iftar meal, a DW bolus with 20% increment given 20min preprandial as split bolus 70/30 over 4h, optimized both early and delayed PPG excursions.