Insulin Calculation in Pediatric Diabetic Patients
Initial Dosing
- The American Diabetes Association recommends an initial total daily dose of 0.5-1.0 units/kg of body weight for children with newly diagnosed type 1 diabetes, with adjustments based on age, pubertal status, and presence of ketoacidosis 1
- Children with type 1 diabetes may require dosing at the lower end of this range, especially younger and prepubertal children 1, 2
- Infants and young children may need diluted insulin to allow for more precise dosing in 1-unit increments 1
Factors Modifying Initial Dose
- The presence of ketoacidosis increases insulin requirements 1, 4
- Steroid use increases insulin requirements 1, 4
- Pubertal changes increase insulin requirements 1, 2
Insulin Regimen
- A basal-bolus regimen using multiple daily injections (MDI) or an insulin pump is recommended, especially after the honeymoon period 2, 5, 6
- This regimen has been shown to provide stable glucose control and less hypoglycemia 2, 6, 3
Special Considerations
- In young children with erratic eating habits, insulin lispro can be administered after meals to more accurately titrate doses based on actual food intake 2, 6, 3
- In children with more predictable eating habits, dosing insulin before meals results in lower postprandial glucose values 2, 6, 3
Adjustments During Special Situations
- For diabetic ketoacidosis (DKA), an IV infusion of 0.05-0.10 units/kg/hour is recommended 7
- For hyperkalemia, a dose of 0.1 units/kg with 400 mg/kg of glucose is recommended 7