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September 2, 2001

Insulin

Question from Clearwater, Florida, USA:

My two year old daughter was diagnosed with type�1 diabetes six months ago. Is is there a formula by which I can calculate the insulin (Humalog) dose that a child who weights X pounds and who eats Y grams of carbs needs in order to return to her pre-meal blood glucose level?

Answer:

The formula (algorithm) we are currently applying with our patients for preprandial insulin is as follows: one carbohydrate (CHO) unit (12 grams of CHO) = 1.5 Units of Regular/analog insulin. This is independent of the body weight which is used to calculate basal insulin requirements.

I suggest you talk with your daughter’s diabetes team about this issue.

MS
Additional comments from Dr. Stuart Brink:

There is no formula that can be applied to every person. For adults, 1 units of fast acting insulin usually covers 15 grams of carbohydrates, but there are many exceptions. For instance, in many very young children 0.1 unit of analog insulin often covers 15 grams of carbohydrates. We do this very individually and fine-tune based upon lots of blood glucose readings before and after meals to see how this works, make further adjustments etc. A lot of the guestimates are based upon total insulin dose/day, insulin dose expressed as units/kg/day etc. Your diabetes team who knows you and your child should be able to do this with you quite nicely.

SB
Additional comments from Dr. Larry Deeb:

I agree that the carb to insulin ratio is individualized. I would start with 1 to 20 likely for this age or even more.

LD
Additional comments from Lois Schmidt Finney, diabetes dietitian:

I do not think you should aim for a return to her pre-meal blood glucose level, especially if it is in the low range. We do plan with children, especially young children, that their blood glucoses after meals will be a little higher so that can take into account any activity that may come up. I am afraid you might be trying to run “too tight of a ship”. Please do the frequent blood glucose monitoring, but remember you little girl needs to be a little girl first, with diabetes second, not a person with diabetes who happens to be a little girl.

LSF

[Editor’s comment: In a child your daughter’s age, I suspect that this algorithm will most likely be too high. There really is no formula as each individual responds differently. Many factors play a role. I would suggest that you start with a low insulin/carb ratio (about 0.5 units per 15 grams of carbohydrate) and check before and two-hour postprandial blood sugars, to determine what works best for your daughter.

You may also want to purchase Stop the Rollercoaster.

SS]

[Editor’s comment: My motto is “start low, go slow.” It’s rarely a situation where speed of adjustment is necessary, and avoidance of hypoglycemia is important.

WWQ]