The International Journal of Romanian Society of Endocrinology / Registered in 1938

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October - December 2021, Volume 17, Issue 4
Case Series

Rohilla L, Dayal D, Gujjar N, Walia P, Kumar R, Yadav J

Mealtime Bolus Insulin Dose Timing in Children with Type 1 Diabetes: Reallife Data from a Tertiary Care Centre in Northern India

Acta Endo (Buc) 2021, 17 (4): 528-531
doi: 10.4183/aeb.2021.528

Context. Mealtime insulin bolus is traditionally administered before meals in children with type 1 diabetes (T1D). Controlled studies on the use of pre-and postprandial insulin bolus have shown variable results. There are no realworld studies on postprandial bolusing of insulin in young children with T1D. Methods. Children with T1D aged <7 years were grouped into preprandial (Group 1) or postprandial (Group 2) groups according to the practice of prandial insulin use. Their retrospective data on mean glycosylated hemoglobin (HbA1c), hypoglycemic events, and diabetic ketoacidosis (DKA) episodes were compared. Results. Forty-four children (mean age 4.1±1.3 years, range 2-7 years) with mean diabetes duration of 2.0±0.7 years (range, 1-4 years) were identified; 23 (52.3%) belonged to Group 1 and 21 (47.7%) to Group 2. There were no differences in the mean HbA1c levels, mean hypoglycemic events, and DKA episodes between the two groups during a mean follow-up duration of two years. Conclusion. Young children with T1D administered insulin bolus during or immediately after meals showed similar long-term glycemic control and diabetesrelated adverse event profile compared to the premeal timing of insulin bolus. Larger real-world studies are needed on flexible insulin bolus timing in young children with T1D.

Keywords: Type 1 diabetes, mealtime insulin bolus, young children, rapid-acting insulins

Correspondence: Prof. Devi Dayal, Post Graduate Institute of Medical Education and Research, Endocrinology and Diabetes Unit, Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Sector 12, Chandigarh, 160012, India, E-mail: