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Diabet. Med. 27, 480–484 (2010) Aims We assessed an extended interruption of subcutaneous insulin delivery during overnight closed-loop glucose control in children and adolescents with Type 1 diabetes (T1D). Methods In seven young subjects with T1D [age 14.2 ± 2.1 years, diabetes duration 6.9 ± 4.0 years, glycated haemoglobin (HbA1c) 8.0 ± 1.5%, body mass index (BMI) 21.4 ± 4.0 kg/m2, total daily insulin dose 0.9 ± 0.2 units/kg/day; mean ± sd) participating in overnight closed-loop glucose control studies, insulin delivery was interrupted for at least 90 min on the basis of predicted hypoglycaemia, low prevailing glucose levels or a too-steep decline in glucose levels. Results Insulin delivery was interrupted for 165 (105, 210) min [median, interquartile range (IQR)]. Plasma glucose was 6.2 ± 3.2 mmol/l at the time of interruption and 5.5 ± 2.0 mmol/l 105 min later ( P = 0.15, paired t-test). Plasma glucose declined during the first hour of the interruption at a rate of 0.02 ± 0.03 mmol/l per min and reached a nadir of 5.2 ± 2.7 mmol/l; 105 min after the interruption, plasma glucose was increasing at a rate of 0.01 ± 0.03 mmol/l per min. When insulin delivery restarted, plasma glucose was 6.4 ± 2.2 mmol/l and peaked at 7.9 ± 2.1 mmol/l in 60 min ( P = 0.01). Physiological levels of plasma insulin were measured throughout with a nadir of 119 ± 78 pmol/l. Conclusions A prolonged interruption of insulin delivery during overnight closed-loop glucose control to prevent hypoglycaemia was not associated with an increased risk of hyperglycaemia in young people with T1D. [ABSTRACT FROM AUTHOR]

Abstract Aims The long duration of action of soluble insulin given in the evening could contribute to the high prevalence of nocturnal hypoglycaemia seen in young children with Type 1 diabetes mellitus (T1DM). We examined whether replacing soluble insulin with insulin lispro reduced this risk in children on a three times daily insulin regimen. Methods Open crossover study comparing insulin lispro vs. soluble insulin in 23 (16 boys) prepubertal children (age 7–11 years) with T1DM on three injections/day; long-acting isophane insulin remained identical. At the end of each 4-month treatment arm, an overnight 15-min venous sampled blood glucose profile was performed. Results Despite similar blood glucose levels pre-evening meal (lispro vs. soluble: mean ± se 6.5 ± 1.0 vs. 7.1 ± 1.1 mmol/l, P = 0.5), post-meal (18.00–22.00 h) blood glucose levels were lower on insulin lispro (area under curve 138 ± 12 vs. 170 ± 13 mmol min-1 l-1 , P = 0.03). In contrast, in the early night (22.00–04.00 h) the prevalence of low blood glucose levels (< 3.5 mmol/l) was lower on lispro (8% of blood glucose levels) than on soluble insulin (13%, P = 0.01). In the early morning (04.00–07.00 h) mean blood glucose and prevalence of low levels were no different between the two treatment groups, and fasting (07.00 h) blood glucose levels were similar (6.1 ± 0.8 vs. 6.3 ± 0.9 mmol/l, P = 0.8). At the end of each treatment arm there were no differences in HbA1c (lispro vs. soluble 8.6% vs. 8.4%, P = 0.3), or in insulin doses (mean, range 0.97, 0.68–1.26 vs. 0.96, 0.53–1.22 U/kg per day, P = 0.2). Conclusions The shorter duration of action of insulin lispro given before the evening meal may reduce the prevalence of early nocturnal hypoglycaemia without compromising HbA1c in young children with T1DM. [ABSTRACT FROM AUTHOR]