Abstract
Objective: Intensive insulin management (IIM) improves glycemic control, and lowers the risks of long-term microvascular complications. In children, the use of insulin Glargine for IIM has been limited by the shorter period of action (<24h), and the need for additional insulin injections. We determined the short term effects of mixing insulin Glargine with short acting insulin (SAI), and dividing the dose into twice daily, on glycemic control in children with type 1 diabetes (T1DM).
Methods: Subjects with T1DM who were receiving glargine were studied on three different occasions. At baseline (Study B), subjects administered one dose of glargine and received 3 SAI injections. Subjects were then randomized to Study Mix and Study Separate (Sep). Study Mix:10 days of administration of a  divided dose of Glargine into two halves given mixed with SAI twice daily and a lunch SAI. Study Sep was similar to Study Mix, except Glargine and SAI were given as separate injections. Glycemic control was evaluated using the CGMS® on final 3 days of each regimen.
Results: 13 subjects (6M/7F, 13.5 ± 0.5 y, 22.4 ± 1.0 kg/m2, hemoglobinA1c of 7.7 ± 0.2% and T1DM duration  44 ± 8 mo) were studied. Mean 24h glucose was 9.3 ± 1.3 mmol/l, 8.3 ± 1.1 mmol/l and 9.3 ± 1.3 mmol/l for study B, Mix, and Sep respectively (p <0.6).
Conclusion: Mixing insulin Glargine with SAI does not affect glucose excursions. This will simplify the use of Glargine, decrease additional injections of insulin, and make IIM therapy in children more realistic.