Injection-meal interval: recommendations of diabetologists and how patients handle it

Because regular insulin does not lower blood glucose immediately after inje ction many physicians recommend an injection-meal interval (IMI). By asking patients to inject well before beginning a meal, these physicians hope to compensate for the lag time between the injection of insulin and its onset of action. The aim of our study was to find out what physicians recommend t o their patients with respect to the IMI, when prescribing intensive insuli n therapy. A total of 58 diabetologists were surveyed by means of a structu red questionnaire. A fixed IMI of 15 (0-30) min [median (range)] was recomm ended by 29% of the 58 diabetologists, and a flexible IMI was recommended b y 71%. The minimal interval for the suggested flexible IMI was 0 min and th e maximal interval 45 min (median 23 min). We compared these results with f indings of 192 patients with Type 1 diabetes from a population based study. In this study patients were asked by questionnaire about their daily life handling of the IMI. Among the group of 134 patients reporting use of a fle xible IMI, 62% used an IMI of less than or equal to 15 min, 16% one of 20-2 5 min, and 21% one of greater than or equal to 30 min. There were 12 patien ts using a flexible IMI who adapted it so frequently that they could not st ate a typical interval. A total of 58 patients (30%) used a fixed IMI (67% used an IMI of less than or equal to 15 min, 7% one of 20-25 min, 26% one o f greater than or equal to 30 min). Our surveys show that diabetologists ad vocating intensive insulin therapy usually recommend an IMI shorter than 30 min. The majority of patients (75%) with Type 1 diabetes use an IMI of < 3 0 min in daily life. (C) 1999 Elsevier Science Ireland Ltd. All rights rese rved.