Timing is everything: results to an observational study of mealtime insulin practices

The purpose of this study was to evaluate the timing and practices of blood glucose testing and rapid-acting insulin administration around mealtimes.

This study used an observational, descriptive design to assess the time between blood glucose testing and insulin administration and the time between first bite of the meal and insulin administration.

The setting was 4 cardiology units in 2 hospitals within a large community healthcare system.

Sixty-four mealtime practice events at breakfast, lunch, and supper were observed.

Investigators directly observed the timing of rapid-acting insulin administration at 3 mealtime periods an assessed timing of blood glucose testing, food intake, and method of glucose reporting.

Overall, 14% (n = 64) of the patients received blood glucose testing within 1 hour prior to insulin administration and insulin administration within 15 minutes of the meal. As separate elements, blood glucose testing was done within the defined ideal range 35% (n = 63) of the time, and insulin was administered within range 40% (n = 58) of the time.

Timing for meals, blood glucose testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various patient caregivers with low achievement of ideal practices.

Results to this study revealed opportunities for better coordination of mealtime insulin practices. Lack of coordination can lead to medication errors and adverse drug events. Further study should include effect of mealtime coordination on glycemic control outcomes and testing the effect of interventions on timing of mealtime insulin practices.