Initiating Insulin Therapy in Type 1 Diabetes

Initial Insulin Regimen

The American Diabetes Association recommends starting intensive insulin therapy immediately using either multiple daily injections or continuous subcutaneous insulin infusion, with rapid-acting insulin analogs for meals and long-acting analogs for basal coverage 1
The initial total daily insulin dose should be 0.5-1.0 units/kg/day, with approximately 50% as basal insulin and 50% as prandial insulin, according to the American Diabetes Association 2
Adolescents typically require doses toward the higher end (closer to 1.0 units/kg/day) due to pubertal insulin resistance, as stated by the American Diabetes Association 2

Rapid-acting insulin analogs (aspart/Novolog, lispro/Humalog, or glulisine/Apidra) should be used for prandial coverage, given 0-15 minutes before meals, as recommended by the American Diabetes Association 1
Long-acting insulin analogs (glargine, detemir, or degludec) should be used for basal coverage, with once daily administration, according to the American Diabetes Association 1

The American Diabetes Association recommends targeting an A1C <7.5% for adolescents, with individualized goals based on hypoglycemia risk 1
A1C should be measured every 3 months, and blood glucose should be monitored frequently during initial stabilization, as stated by the American Diabetes Association 1

The American Diabetes Association recommends screening for celiac disease with IgA tissue transglutaminase (tTG) antibodies and total serum IgA level, with repeat testing at 2 and 5 years after diagnosis 6
Thyroid screening should be performed with anti-thyroid peroxidase (anti-TPO) antibodies and TSH measurement once metabolically stable, with repeat testing every 1-2 years, as recommended by the American Diabetes Association 5
Lipid screening should be performed with a fasting lipid profile once glycemic control is established, with repeat testing every 3-5 years, according to the American Diabetes Association 6

Islet autoantibodies (GAD, IA-2, ZnT8) should be measured if diagnosis is uncertain, particularly in overweight/obese adolescents, as stated by the American Diabetes Association 1
C-peptide measurement may be considered to distinguish type 1 from type 2 diabetes, according to the American Diabetes Association 1

Screening tests for celiac and thyroid disease should not be delayed, and should be performed soon after diagnosis when metabolically stable, as recommended by the American Diabetes Association 6
NPH insulin should not be used as basal insulin, and regular insulin should not be used for meals, according to the American Diabetes Association 1
Glucagon should be prescribed and education provided for emergency hypoglycemia treatment, as stated by the American Diabetes Association 4