Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with Type 1 diabetes

Abstract Introduction The association between short sleep duration and poorer glycemic control in adolescents ages 10-16 with type 1 diabetes (T1D) is well established. Researchers have used cross-sectional, between-subjects’ methods, with limited focus on the potential intraindividual variation among these variables. The purpose of this analysis was to examine the within person associations between glucose variability indices (J index, low/high blood glucose index, time in range) and sleep characteristics (bedtime, waketime, total sleep time, sleep efficiency, wake after sleep onset [WASO], awakenings, and sleep fragmentation index) in adolescents with T1D. Methods Adolescents monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and either their own continuous glucose monitor (CGM) or a provided blinded CGM. General linear mixed models (GLMM) were used to determine within-person and day level associations. Results The sample included 38 adolescents (M age 13.4±1.8; 37.8% male; M A1C 8.2±1.2%). Average glucose levels were controlled in all GLMMs. Adolescents had earlier waketimes on days when more time was spent in hypoglycemia <70mg/dL (β=-0.15, p<0.001). At the person level, adolescents had greater WASO with more % time spent in severe hypoglycemia <54mg/dL with more severe low blood glucose indices (β=0.35, p<0.01 and β=0.34, p<0.01 respectively). At the daily level, adolescents had greater WASO (β=0.20, p=0.01) and more awakenings (β=0.16, p=0.04) on the days they had more overall glucose variability (J index) and more severe high blood glucose indices (β=0.17, p=0.04), but were less likely to have more % time in hypoglycemia (β=-0.15, p=0.02). Conclusion Glucose variability was positively associated with poor sleep (e.g., WASO and awakenings) in adolescents with T1D both at the daily and intraindividual level. Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person associations between habitual short sleep duration and glucose variability. Support NINR T32NR0008346 & P20NR014126, Medtronic MiniMed provided CGMs at a discounted rate for the study.

Download Full-text

Switching to insulin glargine 300 U/mL from other basal insulin analogues provides less 24-hour glucose variability in hospitalized patients with type 1 diabetes

2018 11th International Multiconference Bioinformatics of Genome Regulation and Structure\Systems Biology (BGRS\SB) ◽

10.1109/csgb.2018.8544728 ◽

2018 ◽

Author(s):

V.V. Klimontov ◽

E.A. Koroleva ◽

O.N. Fazullina

Keyword(s):

Type 1 Diabetes ◽

Insulin Glargine ◽

Basal Insulin ◽

Glucose Variability ◽

Insulin Analogues ◽

Hospitalized Patients

Download Full-text

Healthy Pregnancy and Birth during Unusually Long-Lasting Remission of Type-1 Diabetes: Case Report

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2019/asjbccr.6175 ◽

2020 ◽

Vol 3 (1) ◽

pp. 1-5

Author(s):

Fövényi J ◽

Pánczél P ◽

Thaisz E

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Insulin Glargine ◽

Basal Insulin ◽

Insulin Dose ◽

Challenge Test ◽

Tolerance Test ◽

Oral Glucose ◽

Daily Insulin

The 26-year-old woman was diagnosed with type 1 diabetes in 2014. The diagnosis was confirmed while there was a slight increase in blood glucose and HbA1c levels using oral glucose tolerance test, determination of insulin levels and GADA testing. This was followed by a 2-year period with complete remissions and partial remissions of 2-8 U daily basal insulin glargine. Thereafter, the patient became pregnant. The minimal basal insulin used to date has been switched to human rapid-acting and NPH insulins five times daily, which had to be increased to 11 times the initial dose in the third trimester of pregnancy. After a successful spontaneous birth of a healthy baby girl, our patient wished to return to one-tenth of the maximum insulin dose that was used during pregnancy, to once daily insulin glargine. After three months, her blood glucose levels began to rise, with oral glucose challenge test showing a marked increase in blood glucose and a drastic reduction in C-peptide levels. This was when we switched to multiple daily insulin administration using glargine basal- and glulisine analogue insulins. Later, glargine was switched to insulin degludec, and with a 30-33 U total daily insulin dose and CGM for the past two years, the patient was in a satisfactory metabolic state.

Download Full-text

Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2012.10.024 ◽

2013 ◽

Vol 99 (1) ◽

pp. 19-23 ◽

Cited By ~ 101

Author(s):

A.S. Brazeau ◽

H. Mircescu ◽

K. Desjardins ◽

C. Leroux ◽

I. Strychar ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Glucose Variability ◽

Carbohydrate Counting ◽

Blood Glucose Variability

Download Full-text

Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-02384 ◽

2019 ◽

Vol 104 (11) ◽

pp. 5217-5224 ◽

Cited By ~ 6

Author(s):

Saeed Reza Toghi-Eshghi ◽

Jane E Yardley

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Resistance Exercise ◽

Blood Glucose Concentration ◽

Venous Blood ◽

Glucose Monitoring ◽

Glucose Variability ◽

Interstitial Glucose ◽

Design And Methods

Abstract Objective To determine the effect of morning exercise in the fasting condition vs afternoon exercise on blood glucose responses to resistance exercise (RE). Research Design and Methods For this randomized crossover design, 12 participants with type 1 diabetes mellitus [nine females; aged 31 ± 8.9 years; diabetes duration, 19.1 ± 8.3 years; HbA1c, 7.4% ± 0.8% (57.4 ± 8.5 mmol/mol)] performed ∼40 minutes of RE (three sets of eight repetitions, seven exercises, at the individual’s predetermined eight repetition maximum) at either 7 am (fasting) or 5 pm. Sessions were performed at least 48 hours apart. Venous blood samples were collected immediately preexercise, immediately postexercise, and 60 minutes postexercise. Interstitial glucose was monitored overnight postexercise by continuous glucose monitoring (CGM). Results Data are presented as mean ± SD. Blood glucose rose during fasting morning exercise (9.5 ± 3.0 to 10.4 ± 3.0 mmol/L), whereas it declined with afternoon exercise (8.2 ± 2.5 to 7.4 ± 2.6 mmol/L; P = 0.031 for time-by-treatment interaction). Sixty minutes postexercise, blood glucose concentration was significantly higher after fasting morning exercise than after afternoon exercise (10.9 ± 3.2 vs 7.9 ± 2.9 mmol/L; P = 0.019). CGM data indicated more glucose variability (2.7 ± 1.1 vs 2.0 ± 0.7 mmol/L; P = 0.019) and more frequent hyperglycemia (12 events vs five events; P = 0.025) after morning RE than after afternoon RE. Conclusions Compared with afternoon RE, morning (fasting) RE was associated with distinctly different blood glucose responses and postexercise profiles.

Download Full-text