THE TIMING OF MEAL INSULIN ADMINISTRATION

In the October issue of the Endocrine Practice, Peters and coworkers (1) presented an interesting and informative study describing the insulin injection patterns of a large cohort of individuals with type 1 diabetes (T1D). This cross-sectional study of 21,533 patients reported that almost a third of this population routinely injected their insulin during or after the meal. Not surprisingly, this group was also characterized by worse glucose control as measured by glycated hemoglobin (HbA1C). In children who took their insulin during or after a meal, increased diabetic ketoacidosis (DKA) and hypoglycemia were also observed. Because the data were obtained from a patient questionnaire, the authors were not able to determine the rationale for this behavior. Certainly there are valid reasons for injecting insulin after a meal, such as severe gastroparesis in which carbohydrate absorption may be delayed, but for the majority of individuals, injecting insulin prior to a meal is sound advice.