ESPE Abstracts

Background and aim: Severe hypoglycemic episodes during the daytime of Ramadan fasting is the most feared complication. Sensor-augmented pump therapy with insulin in combination with automatic insulin shutoff (low glucose suspend (LGS)) can be used to reduce hypoglycemia. In a prospective observational study, we investigated the effect of the LGS algorithm on the frequency of hypoglycemia in adolescents with type 1 diabetes who wished to fast Ramadan 2013.

Subjects and Methods: Thirty-seven patients (23 males and 14 females, 15.6±3.3 years, duration of diabetes 4.9±4.2 years, pump therapy for 1.8±1.1 years, used the Paradigm^® Veo system (Medtronic) and were divided into two groups: first (n=21): those who wished to wear the sensor and use LGS feature. Second (n=16): those who did not want to wear sensor and measured their BG level regularly.

Results: A total of 2,314 LGS alerts occurred, and 70% began in the afternoon between 1400 and 1700 h. The mean duration of LGS events was 26.55 min, 38% lasted for <5 min, and 7% lasted for 120 min. Among these episodes, the mean sensor glucose was 61.3±9.4 mg/dl at LGS activation, rose to 110.7±34.6 mg/dl by the end of the LGS episode (when insulin delivery was automatically resumed), and was 163.33±42.1 mg/dl at 240 min. Compared to the second group, LGS usage significantly reduced the number of BG readings <70 mg/dl (P=0.001) and >250 mg/dl (P=0.03). Non of the LGS group broke their fast vs 8 in the second group (P=0.02). No episodes of severe hyperglycemia or DKA were observed in both.

Conclusions: This confirms the advantages provided by insulin pump with LGS feature used in diabetic patients who wishes to fast Ramadan. Use of the LGS significantly reduced exposure to hypoglycemia without compromising safety.