Recommended Reading and Resources

References

Synthetic insulin action and pharmacokinetics

These papers underpin the discussion in Part 1 of how rapid-acting insulin behaves biologically, including the dose-dependent extension of the insulin tail.

• Hirsch et al. (2020), Endocrine Reviews, 41(5), 733-778.
• Donnor & Sarker (2023), NCBI Bookshelf.
• Slattery et al. (2018), Diabetes Care.

Insulin on Board and the concept of net IOB

This paper is essential reading for anyone who wants to understand the structural tension in current IOB models. It is referenced directly in Part 2.

• Riddell et al. (2024), The netIOB paper.

Activity, exercise, and insulin on board

These papers provide the scientific foundation for the exercise-related content in Parts 4, 5, and 6, and for the physiological IOB modelling used in the two Explorers.

• Bergford et al. (2023), T1DEXI dataset analysis examining IOB at the start of exercise as a predictor of hypoglycaemia risk.
• Pemberton et al. (2023), GlucoseLo: T1DEXI dataset analysis examining activity-related glucose-lowering in Type 1 diabetes.
• GlucoseGo (2026), T1DEXI dataset analysis examining exercise-related glucose outcomes with units-per-kilogram IOB modelling.

Ultra-rapid insulin pharmacokinetics and AID (Pack 4, April 2026)

These papers inform the new section in The IOB Trade-Off on ultra-rapid insulin in AID systems, and the 15% exercise IOB uplift applied to the GNL exercise explorers.

• Leohr et al. (2021). Pooled PK/PD analysis of URLi (Lyumjev) vs Humalog across 190 participants: 5 min faster onset, 8x greater early exposure, 35% less late action beyond 4 hours.
• Leohr et al. (2026). Lyumjev exercise PK comparison (Diabetes Care). Free insulin lispro rises in the first 15 minutes of exercise; Lyumjev attenuates glucose drop during activity. Evidence basis for the 15% IOB exercise uplift.
• Rakab et al. (2025). Systematic review and meta-analysis of 12 RCTs: ultra-rapid insulin in AID produces less than 1 percentage point TIR improvement (not significant); glycaemic variability significantly reduced (CV -0.78%, p=0.02).
• Moser, Zaharieva, Pemberton, Riddell et al. (2025). EASD/ISPAD position statement on AID and exercise. System-by-system IOB management guidance for physical activity.
• Bassi et al. (2025). 780G AIT 3h to 2h transition (n=91): +3pp TIR, +3.7pp tight-range, no increase in hypoglycaemia. Key safety evidence for closing the IOB configuration gap.

These papers, together with the foundational pharmacokinetic and exercise research above, provide the scientific foundation for the concepts discussed throughout this guide.

Acknowledgements

A special thank you to Simon Helleputte, MSc, PhD (Faculty of Medicine and Health Sciences, Ghent University) and Joseph Henske, MD, FACE (Director of the Diabetes Program, Professor of Medicine, Division of Endocrinology and Metabolism) for their generous feedback and thoughtful input during the development of this guide.

Deep gratitude to Professor Michael Riddell (York University, Canada) for his ongoing support, patience with very lengthy emails, and his ability to continually steer the discussion back to the most important question: “So what?” His perspective has been instrumental in helping refine the practical implications of insulin-on-board modelling and why it matters for people living with Type 1 diabetes.

I am also grateful to colleagues who proofread parts of the guide and offered helpful feedback.

Finally, a huge thank you to the GNL Team, whose support, creativity, and friendship continue to make this work possible.

• Anjanee Kohli, Creative Director and my rock
• Professor Othmar Moser, my brother from another mother
• Professor Dessi Zaharieva, my sister from another mister
• Professor Adrian Brown, long-time dancing partner in the world of metabolic research and evidence-based practice