Weight-based glucose best for tackling hypoglycemia in pump users
medwireNews: Taking a weight-based dose of glucose resolves hypoglycemia more effectively than taking a standard fixed dose for type 1 diabetes patients using an insulin pump, show the results of a randomized crossover trial.
Hypoglycemia was 3.12-fold more likely to resolve within 10 minutes after a single treatment in adults and 2.61-fold more likely to resolve in children when they used weight-based rather than fixed doses and did not result in “excessive” rebound hyperglycemia, report Lindsay McTavish (University of Otago, Wellington, New Zealand) and co-researchers.
The team’s study involved 35 insulin pump users, comprising 20 adults with an average age of 38.4 years and 15 children with an average age of 11.4 years. The study was based on real-world management of hypoglycemia, with patients self-administering glucose when they became aware of a hypoglycemic episode, of which they had 286 in total.
“Whilst we have previously shown that a weight-based glucose treatment protocol is superior to a standard dose in people on multiple daily injections with a basal insulin and mealtime insulin analogues, it cannot be assumed that this is also be true for those using [continuous subcutaneous insulin infusion] for whom the profile of insulin is different,” say the researchers.
When patients used the weight-based glucose dosing, they took 0.3 g per kg of bodyweight if their capillary glucose levels were between 3.0 and 3.9 mmol/L, doubling the dose for levels of 2.0–2.9 mmol/L and suspending insulin infusion until resolution of symptoms if glucose levels were even lower.
This resulted in 82% of episodes in adults and 81% of those in children resolving within 10 minutes of the initial dose, at which point glucose levels had increased by an average of 1.5 and 1.3 mmol/L, respectively, from the pretreatment level.
When patients used standard dosing, adults took took 15 g of glucose and children 10 g, doubling this for capillary glucose levels of 2.0–2.9 mmol/L and suspending pump infusion for lower levels. Just 60% of episodes in adults and 62% of those in children resolved within 10 minutes, with glucose levels rising by a respective 1.1 and 0.8 mmol/L.
Patients repeated the treatment if their glucose level had not reached 4.0 mmol/L by 10 minutes after the first dose.
“[U]sing a higher dose of glucose when capillary glucose is <3.0 mmol/l was effective in reducing the rate of re-treatment required at 10 min, and should be considered in revisions of hypoglycaemia management protocols,” the team writes in Diabetic Medicine.
Rates of rebound hyperglycemia (≥8 mmol/L after 30 min) were slightly but not significantly higher with weight-based than fixed-dose glucose treatment, at 54% versus 40% in adults and 46% versus 41% in children.
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