The snack is critical for the blood glucose profile during treatment with regular insulin preprandially

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Abstract
Objectives. To evaluate how a snack influences the blood glucose profile during treatment with preprandial regular human insulin. Design. In a randomized study a mid‐morning snack either was or was not served. Insulin was given 30 min before the usual breakfast of the patients. Plasma free insulin and blood glucose were repeatedly determined for 5 h. Setting. Outpatient clinic at a university hospital. Subjects. Twenty patients with type 1 diabetes treated with multiple injections of regular insulin (Actrapid®) and eight non‐diabetic subjects. Interventions. A mid‐morning snack either was or was not served 2 h after the usual morning insulin injection. Main outcome measures. A difference in the blood glucose profile after a mid‐morning snack. Results. With a snack there was no difference in blood glucose fasting and at 12.30 h, whilst without a snack there was a decrease of almost 4 mmol L−1, several patients experienced low blood glucose and three had hypoglycaemia. An extended peak of free insulin was reached 30 min after the insulin injection with a slow decrease to the fasting level after 5 h. After the insulin injection a significant decrease in blood glucose occurred within 30–45 min Conclusions. A snack 2 h after the insulin injection results in a smoother blood glucose profile and reduces the risk of hypoglycaemia in patients with type 1 diabetes treated with preprandial regular human insulin. Furthermore, the recommended interval of 30 min between insulin injection and a meal may be too long.

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