Frequency of mealtime insulin bolusing (BOLUS) is a promising new objective assessment of adherence in youths with type 1 diabetes (T1D). We read with interest the recent article by Alemzadeh et al. Eleven alternative models of insulin kinetics have been proposed implementing a number of putative characteristics. Others liked and chose to use advisors because they saved time and effort calculating doses and/or had a data storage facility. The CarbF determines the size of the bolus that will be recommended for the grams of carb in a meal. The primary outcome was postprandial hypoglycemia. A seven-point self-monitored blood glucose (SMBG) was obtained twice weekly.
Sensitivity analyses showed the results were robust under a range of plausible scenarios. Think of it as giving the insulin a “head start” in the race against the food digesting and raising your blood sugar. During the evening and early morning hours, there is an increased insulin resistance, requiring higher insulin levels to maintain normal glucose levels. You will test your blood glucose four or more times a day, typically before meals, snacks and bedtime. Multiple linear regression analysis showed that the variations in HbA1c could be explained by the frequency of bolus doses (p = 0.013) and SMBG per day (p < 0.0001) adjusted for duration and age (r(2) = 0.339, p < 0.0001). A general rule for insulin dose adjustments is to fix the fasting first. Those who missed doses were less satisfied and perceived more impact with the treatment. Then, after around four to five hours, there will be a sharp rise in blood sugar, because now the carbohydrates start acting – but not the insulin. Subjects were instructed in SMBG and asked to test at least five times daily (before meals, 2 h postprandially, bedtime).