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February 14, 2003

Insulin

Question from Michigan, USA:

My friend has a 10 year old with type 1 diabetes who is on 25/75 insulin, and I've been asking her to confront her "team" and ask them for some evidence that 25/75 works for kids with type 1. Her son's A1c is now over 10%. Do you know off-hand of any abstracts or articles I could send her to present to the team that 25/75 isn't the best route for kids and teens?

Answer:

I think that you should be a little cautious about advising your friend against two shots a day of 25/75. It is not, of course, a regimen designed to achieve the optimum in control; but it is still a pattern of insulin administration that is used occasionally as quite an effective compromise in any situation where the family may be dysfunctional.

I have an idea that the person to talk this over with in the diabetes care team may be the Medical Social Worker.

DOB
Additional comments from Dr. Larry Deeb:

I sometime use 75/25 three times a day. Why: some kids can’t carb count very successfully. And some do skip doses — the A1c of 10+ makes you wonder about this.

The small frequent doses seem to cover the day and night and avoid the very highs when doses are skipped.

LD