For people with type 1 diabetes (and some with type 2), the question is simple-and crucial: How much insulin should you give yourself with a meal?
The calculation of that bolus dose of insulin can alter the course of your day. If your blood sugar is too high after a couple of hours, you’ll have to give yourself more insulin. If it’s too low, you’ll have to find something else to eat. And those errors can lead to even further swings in blood sugar.
Wouldn’t it be better to take precisely the right dose, every time? Well, perfection might not be possible, but greater accuracy and improved A1c levels most certainly are, according to a new study recently published in the journal Diabetes Care.
Researchers knew that manually calculating bolus doses of insulin took time and was often inaccurate. So they set up a study in which two groups of diabetics with poor control of their disease started intensive-control regimens. One of the groups had a glucose meter with an automatic bolus adviser-a program that would calculate the correct dose of insulin the patient needed for a meal. The other group would work out their bolus doses on their own.
There was good news for both groups. Each saw average reductions in its A1c levels over the length of the study. But the news was better for those with the automatic bolus adviser-those patients saw an average decrease in A1c level of 0.7%. (The folks in the figure-it-by-hand group had an average drop of 0.5%.)
That’s a significant, if small difference. But the study offered further interesting information. The patients in both groups were aiming for a 0.5% reduction in A1c at the minimum-their average starting point was a decidedly mediocre 8.9% . In the automated calculation group, 56 percent of patients made that goal. In the manual calculation group, only 34 percent did.
While pleased with the study’s outcome, researchers suggested that the intense control employed by both groups may have made the results less than accurate in the real world. “A third ‘pure’ control arm with no enhanced care would have allowed a more realistic comparison of bolus adviser versus manual bolus calculation in real-world clinical care,” they wrote.