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Objective: This aim of this study was to investigate the effect of additional insulin dosing for high fat/high energy density mixed meal over 12 hours. Methods: In this single-center, non-blinded, randomized, cross-over study, a high fat/high energy density test meal was used to study the impact on glycemic response of either carbohydrate counting (CC) on the first day and the Pańkowska algorithm (PA) on the second test day. The two methods were compared in 20 adolescents with type 1 diabetes (T1D), aged 9-18 years, using insulin pump therapy and continuous glucose monitoring on postprandial early (0-120 min), late (120-720 min), and total (0-720 min) glycemic response. Results: There was no difference between groups in the duration of normoglycemia in the early period. Postprandially, 50% of patients developed hypoglycemia using the PA at a median of 6.3 (5.6-7.9) hours and the PA was subsequently modified for the remaining ten patients. Area under the curve (AUC) for the early period decreased non-significantly in the CC group, indicating less normoglycemia. No significant difference was found in the AUC of the PA (no hypoglycemia n=4) and modified PA groups (no hypoglycemia n=6) over the whole period (0-12 hours). AUC for level 2 hyperglycemia was statistically greater in the PA-no hypoglycemia patients compared to modified PA-no hypoglycemia patients. Conclusion: There were inter-individual differences in glycemic response to high fat/high energy density meals. An individualized approach to insulin dosing by evaluating food diary and postprandial glucose monitoring appears to be optimal for children and adolescents with T1D. [ABSTRACT FROM AUTHOR]

Aim: Glycemic variability can be affected in diabetes camps as a result of sports, social activities and nutrition. Close glucose monitoring is necessary to reduce glycemic variability, especially hypoglycemia. The aim assessment of glycemic variability and time in range by use of the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes. Materials and Methods: Thirty-three children and adolescents between 10-18 years of age who participated in the 2018 diabetes camp of Ege University were included. Their glycemic variability indexes were recorded. Results: The mean age and duration of diabetes mellitus in the study group was 13.3±0.5 and 4.9±0.7 years respectively. Twelve (43%) of the participants were boys and 16 (57%) were girls. Ten (35.7%) of the participants used continuous subcutaneous insulin infusion (CSII) pump therapy while 18 (64.3%) used multiple dose insulin therapy. When the participants were evaluated according to time in range (TIR), the duration of TIR increased, and level 1 and level 2 hyperglycemia decreased during the camp. Participants using CSII had spent more time in level 2 hypoglycemia before camp, but during and after the camp, similar values were reached for both groups. Before the camp, participants with good metabolic control had a longer duration of hypoglycemia than those participants with poor metabolic control. During and after the camp, level 1 and level 2 hypoglycemia periods were similar between the two groups. Conclusion: In diabetes camp, healthy diet, regular exercise, and close glycemic control improve glycemic variability. By using FGMS, normoglycemia periods can be increased without increasing hypoglycemic attacks. As a result, using FGMS had a positive effect on diabetes management and the control of hypoglycemia periods during the diabetes camp. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the prevalence of impaired hypoglycemia awareness (IHA) in children and adolescents with type 1 diabetes mellitus using a professional continuous glucose monitoring (CGM) system and to show the effect of structured education on glycemic variability (GV) in children and adolescents with IHA. Methods: Forty type 1 diabetic children and adolescents with a diabetes duration of at least five years were eligible for inclusion in this prospective, quantitative study. All subjects were asked about their history of being aware of the symptoms of hypoglycemia using a questionnaire. Professional CGM was conducted in all of the patients for six days. The frequency of IHA detected by comparison of CGM and logbook reports were analyzed. Patients with identified IHA underwent a structured training program. After three months, CGM was re-applied to patients with IHA. Results: The study was completed by 37 diabetic children and adolescents. After the initial CGM, nine patients (24.3%) were found to have had episodes of IHA. Area under the curve (AUC) for hypoglycemia and number of low excursions were; 1.81±0.95 and 8.33±3.60 for the IHA group at the beginning of the study. AUC for hypoglycemia was 0.43±0.47 after three months of structured education the IHA patients (p=0.01). Coefficient of variation which shows primary GV decreased significantly although unstable at the end of education in IHA patients (p=0.03). Conclusion: CGM is a valuable tool to diagnose IHA. IHA, GV and time in range can be improved by education-based intervention. [ABSTRACT FROM AUTHOR]