What is an example of mealtime insulin and basal insulin dosing for a 13-year-old female with new onset diabetes mellitus (DM)?

From the Guidelines

For a 13-year-old female with new onset diabetes, I recommend a combination of basal and mealtime insulin therapy, starting with long-acting insulin such as insulin glargine (Lantus) or insulin detemir (Levemir) at 0.1-0.2 units/kg per day, and rapid-acting insulin such as insulin lispro (Humalog), insulin aspart (NovoLog), or insulin glulisine (Apidra) at 0.1-0.15 units/kg per meal, as supported by the most recent guidelines 1.

Basal Insulin

The initial dose of basal insulin can be calculated based on body weight, with a typical starting dose of 0.1-0.2 units/kg per day, as recommended by the American Diabetes Association 1. For a 13-year-old female weighing approximately 45 kg, this would be about 4.5-9 units daily.

Mealtime Insulin

For mealtime coverage, rapid-acting insulin can be started at a dose of 0.1-0.15 units/kg per meal, adjusted based on carbohydrate intake using an initial insulin-to-carbohydrate ratio of 1:10 to 1:15 (1 unit per 10-15 grams of carbohydrates) 1. This would be approximately 4-7 units per meal.

Monitoring and Adjustments

Blood glucose should be monitored before meals, at bedtime, and occasionally at night to adjust insulin doses appropriately. The patient and family should receive comprehensive diabetes education, including carbohydrate counting, insulin administration techniques, hypoglycemia recognition and management, and sick day rules, as emphasized by the American Diabetes Association 1.

Considerations

It is essential to consider the individual's specific needs, lifestyle, and preferences when determining the insulin regimen, as highlighted by the guidelines 1. The doses will need frequent adjustment during the honeymoon phase when some endogenous insulin production may continue temporarily.

Key Points

• Start with a combination of basal and mealtime insulin therapy
• Calculate initial basal insulin dose based on body weight (0.1-0.2 units/kg per day)
• Use rapid-acting insulin for mealtime coverage (0.1-0.15 units/kg per meal)
• Monitor blood glucose levels and adjust insulin doses accordingly
• Provide comprehensive diabetes education to the patient and family

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Insulin Regimens for Type 1 Diabetes

• The primary goal of treatment for type 1 diabetes mellitus (T1DM) is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications 2.
• Effective insulin therapy must be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of T1DM 2.

Meal Time and Basal Insulin

• Basal-bolus therapy, either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII), is the best therapeutic option for patients with T1DM to achieve target glycemic control 2, 3.
• When using MDI, basal insulin requirements are given as an injection of long- or intermediate-acting insulin analogs, while meal-related glucose excursions are controlled with bolus injections of rapid-acting insulin analogs 2.
• CSII provides a 24-h preselected but adjustable basal rate of rapid-acting insulin, along with patient-activated mealtime bolus doses, eliminating the need for periodic injections 2.

Case of a 13-year-old Female with New-Onset Diabetes

• A 13-year-old female with new-onset type 1 diabetes in diabetic ketoacidosis (DKA) may require individualized insulin therapy to manage her condition 4.
• The choice of insulin regimen, including meal time and basal insulin, should be based on the patient's specific needs and circumstances, taking into account factors such as age, pubertal status, and lifestyle 2, 5.

Comparison of Insulin Regimens

• Studies have compared the effectiveness of different insulin regimens, including MDI and CSII, in patients with type 1 diabetes 3, 5, 6.
• These studies have shown that different insulin regimens can have similar effects on glycemic control, with some regimens being more effective in reducing glycaemic variability and improving glycaemic control 5, 6.