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Insulin dose adjustment when changing from multiple daily injections to continuous subcutaneous insulin infusion in

Esmeralda Colino1, Ma Ángeles Álvarez, Atilano Carcavilla

  • 1Paediatric Diabetes Unit, Department of Paediatrics, Hospital Ramón y Cajal, Alcalá University, Crta de Colmenar Km 9,1, 28034 Madrid, Spain. esmcol@yahoo.es

Acta Diabetologica
|March 26, 2009
PubMed

Insights

Switching pediatric type-1 diabetes patients from injections to insulin pumps requires dose adjustments. Reductions vary by pubertal status and prior long-acting insulin type, with detemir use necessitating greater decreases.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Management

Background:

  • Type-1 diabetes management in children transitioning to insulin pump therapy requires careful dose adjustments.
  • Previous insulin regimens, including long-acting insulin type and patient's pubertal status, may influence optimal pump initiation doses.

Purpose of the Study:

  • To determine appropriate initial insulin dose adjustments for pediatric patients with type-1 diabetes switching from multiple daily injections to continuous subcutaneous insulin infusion.
  • To investigate if pubertal status and the type of prior long-acting insulin affect the required insulin dose reduction.

Main Methods:

  • Retrospective chart review of 60 pediatric patients with type-1 diabetes transitioning to insulin pump therapy.
  • Collection of data on insulin dosage, insulin types, HbA1c, BMI, and adverse events (hypoglycemia, DKA) before and after 6 weeks of pump use.

Main Results:

  • Overall reduction in total daily insulin dose is necessary upon switching to pump therapy.
  • Prepubertal patients required a 19% reduction, while pubertal patients needed a 26% reduction.
  • Patients previously on detemir experienced greater reductions (26% prepubertal, 33% pubertal).
  • The ratio of basal to bolus insulin changed significantly (1.26 to 0.93, P < 0.05).
  • Basal insulin requirements were 40-45% in prepubertal and 45-50% in pubertal patients.

Conclusions:

  • Initial insulin dose reduction is crucial when initiating continuous subcutaneous insulin infusion in pediatric type-1 diabetes patients.
  • The magnitude of dose adjustment is influenced by pubertal status and the specific long-acting insulin used previously, with detemir requiring a more substantial decrease.
  • Optimizing basal insulin percentage is key for successful transition to pump therapy.

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