My four year old daughter was diagnosed in October 2004. She has been using an insulin pump for the past three and a half months. I went to a JDRF coffee recently and other parents of kids using the pump were talking about the percentage of the total daily dose (TDD) of basal insulin. They were saying that it should be around 50%. I was never told anything about this by the pediatric endocrinologist and have been trying to look it up. I only find between 45 to 60% basal. My daughter’s average is 26%. We haven’t had her A1c done since July, but her pump says her 30 day average is 153 mg/dl [8.5 mmol/L]. Is this something that would need to be adjusted so that it was closer to 50% or is it okay to have the basal only at 25%? If I did need to change it, how do you go about doing this without wreaking havoc with her levels?

I agree that, generally, the basal rates of pumpers (even very young ones) are between 40 to 60% of the TDD. In some cases, however, they are lower or higher than that and the children are still in good control. The easiest way to tell if the basal is too high or too low is both to look at the overall pattern of blood sugars and to examine what her blood sugars do when she either delays a mealtime or has a meal that is very low in carbohydrates. If her blood sugar rises without many carbohydrates, then that can be an indication that the basal rate is, indeed, too low (and that you’re using a higher than necessary “carbohydrate to insulin” ratio to cover her basal requirements).

Usually, children under five require very little basal between 2 a.m. and breakfast, as well.

It may be that, depending on when in the course of her disease she was diagnosed, your daughter is also still in a “honeymoon” phase (needing little insulin for her body weight and making some of her own insulin). This also would explain a lower basal. In our practice, we don’t start kids on pumps until they’ve had diabetes for more than one year, so I, personally, don’t have much experience with pumps in honeymooners!

LAD