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Comparison of Diluted Insulin (U10) Versus Standard (U100) Insulin in Automated Insulin Delivery Systems: Reducing

Heidi Falk1, Ada Aaltio1, Mari-Anne Pulkkinen1

  • 1Department of Pediatrics and Adolescence, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland.

Diabetes, Obesity & Metabolism
|July 13, 2026
PubMed

Insights

Diluted U10 insulin in automated insulin delivery systems significantly reduced time below range in young children with Type 1 diabetes. This approach improved glycemic control without increasing hyperglycemia, offering a safer treatment option.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Technology

Background:

  • Managing Type 1 diabetes in very young children (CwT1D) presents unique challenges due to their minimal insulin requirements.
  • Automated Insulin Delivery (AID) systems are increasingly used, but require precise insulin dosing.
  • Investigating the efficacy and safety of diluted insulin (U10) in AID systems for CwT1D is crucial.

Purpose of the Study:

  • To evaluate the safety and glycemic outcomes of using diluted U10 insulin versus standard U100 insulin in an AID system for young children with Type 1 diabetes.
  • To compare the time spent in various glucose ranges (TBR) between children using diluted insulin and a control group.

Main Methods:

  • A cohort of 19 children (0-4 years) using diluted U10 insulin in an AID system with a maximum daily dose of ≤6 units was identified.
  • A control group of 27 age- and gender-matched children using standard U100 insulin in an AID system was selected.
  • Continuous Glucose Monitoring (CGM) data were analyzed longitudinally over 12 months to assess time-by-treatment effects.

Main Results:

  • Diluted U10 insulin use led to a significant reduction in time below 3.9 mmol/L and 3.0 mmol/L within 3 months, which was sustained for 12 months.
  • Children using diluted insulin showed lower time below 3.9 mmol/L at later follow-up visits compared to controls.
  • HbA1c-adjusted analysis revealed a significant between-group difference, with diluted insulin users having 1.85% and 1.52% lower time below 3.9 mmol/L at 9 and 12 months, respectively.

Conclusions:

  • Diluted U10 insulin is a safe and effective option for young children with Type 1 diabetes using AID systems who require low insulin doses.
  • This approach successfully reduces time spent in hypoglycemia (low blood glucose) without inducing hyperglycemia.
  • The findings support the use of diluted insulin to optimize glycemic management in this vulnerable pediatric population.
Abstract

Keywords:
AID settingsAID systemchildren with Type 1 diabetesdiluted insulin

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