Four days ago, I was called to the hospital to see a seven month old female with hunger and in a coma. Upon examination, I saw that she was severely dehydrated, in DKA, and with a blood sugar over 500 mg/dl [27.8 mmol/L]. How common is it for infants to have type 1 diabetes? How is it managed? The child’s mother also has type 1.

While it is rare to see such a young child with type 1 diabetes, it seems that with DKA onset, that there is not much else that this could be. We would manage with a multidose insulin regimen usually an analog (Humalog or NovoLog) before meals based upon capillary blood glucose levels with bedtime Lantus. Sometimes, we split the Lantus, with some in the morning and some in the evenings, and sometimes only morning Lantus. All is not based upon any dogma but based upon actual blood sugar readings. I would be glad to provide some assistance and support to you and your team and also would be available for e-mail consultations. Often, one uses diluted insulin in such very young children and we teach our parents to take either normal saline or diluent from the insulin manufacturers and make a 1:100 dilution so that each line on a standard syringe represents very small amounts incrementally.

If you like, I could also e-mail a chapter that I wrote in my own textbook, Pediatric and Adolescent Diabetes. I could also send an attached file with the specific chapter about such management of the very young with diabetes if this is helpful. Please contact us if you need further assistance.

SB