May 20, 2005
Daily Care, Insulin Analogs
Question from Las Vegas, Nevada, USA:
My child was diagnosed with diabetes on March 17, 2005 at the age of six months. I am trying to come up with some kind of working number for his ISF (insulin sensitivity factor). The 1800/2000 rule does not work for him since his average total daily dose is 2.4 right now. He weighs 18.2 pounds. According to the 1800 rule, he should drop 75 points for each 0.1 unit of NovoLog. This is not even close to reality as 0.2 will take him from 350 mg/dl [19.4 mmol/L] to a coma inside of two hours.
Is there another way to come up with a realistic ISF? My endocrine team has no idea of how. I have to believe that there must be a way to monitor his levels/carbohydrate intake/insulin intake to come up with a number. Waiting until he is big enough for the 1800 rule to work is not an option I want to accept.
Answer:
The “1800 rule”, “1500 rule”, and “500 rule” are all guidelines that are to be used as starting points for insulin adjustments. They are not dogma and may certainly not apply to special situations, such as very young children (who often need very little short acting insulin) or children in their honeymoon or in puberty. Like much of diabetes, for an individual child, there are no good rules except for “whatever works, works”! Many of our youngest children have insulin sensitivity factors that are lower in the morning than in the evening, so you’ll need to look at what happens by time of day as well.
LAD
[Editor’s comment: If you are not already using diluted insulin, you may wish to discuss its use with your endocrine team. This would allow for very small amounts of insulin as your basal and bolus rates.
BH]
