Endocrine Abstracts

Introduction: Recommended starting insulin doses in CYP with newly diagnosed type 1 diabetes vary widely from 0.3 to 1.0 U/kg/day. However, there is no study for rate of change of insulin dose in first few months of initiating insulin.

Aim: Retrospective review of insulin total daily dose at diagnosis, hospital discharge, and at first clinic, documenting changes in % basal insulin with time, considering any impact of insulin treatment on body weight and HbA1c after diagnosis. Local policy advises a starting dose of 0.7 units/kg.

Method: Data for 77 CYP aged 1-16 with newly diagnosed type 1 diabetes were collected over a 4-year period from clinical notes, clinic letters, electronic patient records and diasend® (diabetes data analysis software). Trends of total daily doses of insulin, % basal insulin, ICR, ISF, body weight and HbA1c were reviewed.

Results: The mean age at onset of diagnosis was 10.6 years (range 1.6 to 15.9 years); 55% of male and 45% of female subjects were identified. The median duration from the date of hospital discharge to the time of review at first clinic was 48 days with average number of contacts of 3.4 times in between. 26 children (33.8%) presented with DKA at the time of diagnosis. Total daily dose of insulin decreased from average 0.78 units/kg/day to 0.62 within median 48 days of starting insulin. % Basal insulin increased from 42.7% to 48% along with ICR and ISF trends, indicating the rise of insulin requirement which correlates with the body weight of CYP increasing by 11.2% in the same period. HbA1c trend was reassuring with improvement from average 106.33 mmol/mol at diagnosis to 65.3 mmol/mol at first clinic.

Conclusion: Total daily dose of insulin per weight decreased in first 1-2 months with no significant rise in between discharge and first clinic; the basal percentage remained in the recommended range of 40-50%. The unit initial starting dose seems appropriate.