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Issue 105 Item 6 Split Bolus Insulin Injection More Effective than Single Bolus

Comparing 4 methods to deliver a bolus insulin injection following a meal high in carbohydrates, calories and fat, shows that a dual wave of insulin administration proved the most effective method for managing glucose Investigators from the Department of Pediatrics at the University of Colorado Health Sciences Center in Denver, Colorado, United States, compared four methods of short-acting insulin bolus administration.

Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog®) consumed the same meal on four occasions separated by one week.

At the time of meal consumption, the effectiveness of one of four methods of insulin administration was tested. The four methods were (1) single bolus, (2) two separate boluses, (3) the entire bolus administered as a square wave over two hours or (4) a dual wave consisting of 70 percent given as a bolus and 30 percent delivered as a square wave over two hours. In all cases, administration began 10 minutes before the meal and the final dosage of insulin was the same.

The lowest changes in blood glucose values from fasting to 90 and 120 minutes were achieved with the dual wave administration.

Glucose levels were significantly lower after four hours in both the dual and square-wave method compared with single or double bolus administration.
Diabet Med 2002; 19(4): 317-321