© 2002 Diabetes UK. Diabetic Medicine, 19, 317–321 317 Introduction The importance of good glucose control in preventing diabetic complications is now well accepted [1–3]. However, the means to achieve good control in real life are not well defined. The highest glucose levels of the day for people with diabetes are usually post-prandial. Post-prandial hyperglycaemia has been reported to be at least as important as fasting hyperglycaemia in relation to atherosclerotic disease, fetal and maternal out- come, risk for retinopathy and nephropathy, and mortality from diabetes [4 –12]. There has, however, been a paucity of research on how to best control post-prandial hyperglycaemia. One study showed after a high-fat, high-carbohydrate meal of pizza, tiramisu and non-diet cola, insulin lispro resulted in a 22% reduction in area under the curve in comparison with soluble insulin [13]. Other studies have also shown the superi- ority of insulin lispro in comparison with soluble insulin in Correspondence to: H. Peter Chase MD, Barbara Davis Center, 4200 East 9th Ave, B140, Denver, CO 80262, USA. E-mail: Peter.Chase@uchsc.edu Abstract Aims To determine if one method of short-acting insulin bolus administration is superior to other methods in managing a meal high in carbohydrates, calories and fat. Methods Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog®) agreed to consume the same meal high in carbohydrates, calories and fat on four occasions 1 week apart. They received the same dose of bolus insulin on each of the four occasions randomly assigned and beginning 10 min prior to the meal as either a single bolus, two separate boluses of one- half the same total dose (the second after 90 min), the entire bolus given as a square-wave (over 2 h) or a dual-wave (70% as a bolus and 30% as a square-wave over 2 h). Blood glucose levels were measured at – 60 and – 30 min and at zero time, and then every half-hour for 6 h using the Hemacue® in the out-patient clinic. Results Changes in blood glucose values from fasting were the lowest after 90 and 120 min (P < 0.01) when the dual wave was administered. When the dual or square-wave methods of insulin administration were used, subjects had significantly lower glucose levels after 4 h in comparison with when the single or double boluses were used (P = 0.04). Conclusions We conclude that the dual wave provided the most effective method of insulin administration for this meal. The dual- and square-wave therapies resulted in lower glucose levels 4 h after the meal in comparison with the single and double-bolus treatments. Diabet. Med. 19, 317 – 321 (2002) Keywords Type 1 diabetes, post-prandial glucose, bolus insulin Abbreviations HbA 1c , haemoglobin A 1c ; DCCT, Diabetes Control and Complications Trial Blackwell Science Ltd Oxford, UK DME Diabetic Medicine 0742-3071 Blackwell Science Ltd, 2001 October 2001 19 000 000 Original article Original article Post-prandial glucose control • H. P. Chase et al. Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetes H. P. Chase, S. Z. Saib, T. MacKenzie, M. M. Hansen and S. K. Garg Department of Paediatrics, Barbara Davis Center, University of Colorado Health Sciences Center, Denver, CO, USA Accepted 19 October 2001