Restoring euglycemia in the basal state using continuous glucose monitoring in subjects with type 1 diabetes mellitus

Background: Our objective was to use continuous glucose monitoring to derive the optimal basal insulin infusion rates in adults with type I diabetes and using continuous subcutaneous insulin infusion (CSII) pumps. Methods: In an effort to mimic euglycemia during the basal state, we used a standard protocol to adjust basal insulin infusion rates in 16 subjects with type 1 diabetes mellitus who were using CSII pumps. All subjects wore Continuous Glucose Monitoring System sensors (CGMS((R)), Medtronic Minimed, Northridge, CA) in order to obtain around-the-clock tracings of their glucose measurements. Subjects were asked to skip meals periodically in order to optimize basal insulin infusion rates, defined as the basal infusion rates that maintained glucose levels in the range of 65-120 mg/dL during the fasting state or between meals. Results: In order to demonstrate improved glycemic control, with blunting of glucose excursion, we compared the baseline CGMS area under the curve (AUC) to the AUC obtained after optimizing the basal insulin dosages. We analyzed the curves by determining the AUC for glucose excursions above 110 mg/dL. The AUC for glucose excursions above 110 mg/dL was significantly smaller after optimization (19 +/- 13 mg/dLday) compared to the baseline AUC (50 31 mg/dL-day) (P < 0.001). Conclusions: Using both a standard protocol for initial basal insulin infusion rates and CGMS curves to optimize basal infusion rates, one can improve glycemia in subjects with type 1 diabetes using CSII.