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).
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
adivided 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.
13 subjects (6M/7F, 13.5 ± 0.5 y, 22.4 ± 1.0 kg/m2, hemoglobinA1cof 7.7 ±0.2% and T1DM duration44 ± 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.