Endocrine Abstracts

Objectives: The Diabetes Team at Birmingham Children’s Hospital modified the advanced bolus algorithm suggested by Bell (2015), to develop the KISS (Keep it Simple and Safe). KISS involves adding 25% extra insulin to meals identified as very high fat and protein, and spreading the insulin by a split bolus, 50% now and 50% over 2.5 hours. KISS also has an adjustment tool allowing extra insulin to be added and the split modified from monitoring. KISS is intended to be a simple. The purpose of this one year audit was to assess the effectiveness of KISS, and identify key determinants of when extra insulin is needed. It was hypothesized over half of the patients would use KISS, and that meal carbohydrate grams per kilogram (CHOg/Kg) of the high fat and protein meals would be the main determinant of the need for extra insulin.

Methods: From April 2016 to April 2017, 25 children aged 10.8 years (S.D. 3.7) were initiated onto insulin pump therapy. On the 3rd education session, KISS was taught. All 25 patients pump downloads were analyzed 2 weeks after the session.

Results: Of the 25 patients educated, 68% (n=17) tried KISS at least once. The KISS users were significantly older than the non-users (11.9 years vs 8.5 years, T-Test P<0.01) and no patients aged under 7 years used KISS. Default 1 shows the 28 high fat and protein meals grouped by the extra amount of insulin they required. There was a significant difference between groups for CHOg/Kg. Posthoc analysis shows the meals requiring more than 25% extra insulin had significantly higher CHOg/Kg, when compared to 0% (P<0.01), and 25% extra (P<0.05).

Conclusions: The audit results highlight KISS is simple to use, but may not be used by children under seven years. When deciding if to add extra insulin to defined high fat and protein meals, it may be possible to use the meal CHOg/Kg to determine the extra required. Specifically, no extra insulin for meals under 2.0 CHOg/Kg, 25% extra for 2.0 – 2.5 CHOg/Kg and more than 25% extra for more than 2.5 CHOg/Kg.