What is the basal-bolus insulin regimen construction using a correction factor for an 8-year-old female child with Type 1 Diabetes Mellitus (T1DM), weighing 18 kilograms, using Regular Insulin and Glargine (Insulin Glargine)?

From the Guidelines

The basal-bolus insulin regimen for an 8-year-old female child with Type 1 Diabetes Mellitus (T1DM), weighing 18 kilograms, using Regular Insulin and Glargine (Insulin Glargine) should be constructed with a total daily insulin dose of 0.5 units/kg/day, which is approximately 9 units/day.

Basal Insulin

• The basal insulin dose should be 50% of the total daily insulin dose, which is approximately 4.5 units/day of Glargine, administered once daily.

Bolus Insulin

• The bolus insulin dose should be 50% of the total daily insulin dose, which is approximately 4.5 units/day of Regular Insulin, divided into three meals.
• The correction factor for Regular Insulin is typically 1 unit/50 mg/dL for children with T1DM 1.
• The insulin-to-carbohydrate ratio for Regular Insulin is typically 1 unit/15 grams of carbohydrates for children with T1DM 1.

Example Regimen

• Basal insulin: 4.5 units of Glargine once daily
• Bolus insulin:
  • Breakfast: 1.5 units of Regular Insulin (based on 15 grams of carbohydrates and 1 unit/15 grams ratio)
  • Lunch: 1.5 units of Regular Insulin (based on 15 grams of carbohydrates and 1 unit/15 grams ratio)
  • Dinner: 1.5 units of Regular Insulin (based on 15 grams of carbohydrates and 1 unit/15 grams ratio)
• Correction dose: 1 unit of Regular Insulin for every 50 mg/dL above target glucose level It is essential to note that this is just an example regimen, and the actual doses and ratios may need to be adjusted based on individual factors, such as the child's lifestyle, diet, and activity level, as well as their response to insulin therapy 1. Regular monitoring of blood glucose levels and adjustment of the insulin regimen as needed is crucial to achieve optimal glycemic control and prevent complications 1.

From the FDA Drug Label

In a randomized, controlled clinical study (Study D), pediatric patients (age range 6 to 15 years) with type 1 diabetes (n=349) were treated for 28 weeks with a basal-bolus insulin regimen where regular human insulin was used before each meal. Insulin Glargine was administered once daily at bedtime and NPH insulin was administered once or twice daily.

The basal-bolus insulin regimen construction for an 8-year-old female child with Type 1 Diabetes Mellitus (T1DM) using Regular Insulin and Glargine (Insulin Glargine) is not explicitly described in the provided drug label. However, based on the information from Study D, which included pediatric patients with type 1 diabetes, the regimen may involve:

• Basal insulin: Insulin Glargine administered once daily at bedtime
• Bolus insulin: Regular human insulin administered before each meal
• Correction factor: Not explicitly mentioned in the provided text, but it is a common practice to use a correction factor to adjust the insulin dose based on the patient's blood glucose levels. However, the exact construction of the basal-bolus insulin regimen, including the correction factor, for this specific patient cannot be determined from the provided information 2.

From the Research

Basal-Bolus Insulin Regimen Construction

The construction of a basal-bolus insulin regimen for an 8-year-old female child with Type 1 Diabetes Mellitus (T1DM), weighing 18 kilograms, using Regular Insulin and Glargine (Insulin Glargine) involves several factors, including the child's weight, insulin sensitivity, and dietary habits.

• The total daily dose (TDD) of insulin is typically calculated based on the child's weight, with a common starting point being 0.5-1.0 units/kg/day 3.
• The basal insulin dose is usually 40-50% of the TDD, with the remaining 50-60% allocated to bolus insulin 4, 5.
• The correction factor (CF) is used to adjust the bolus insulin dose based on the child's blood glucose levels, with a common starting point being 100-200 mg/dL per unit of insulin 3.
• The insulin-to-carbohydrate ratio (ICR) is used to adjust the bolus insulin dose based on the child's dietary carbohydrate intake, with a common starting point being 1:10 to 1:20 (1 unit of insulin per 10-20 grams of carbohydrates) 3.

Calculation of Basal and Bolus Insulin Doses

Based on the child's weight (18 kg) and a starting TDD of 0.5-1.0 units/kg/day, the total daily insulin dose would be:

• 18 kg x 0.5 units/kg/day = 9 units/day (lower end of range)
• 18 kg x 1.0 unit/kg/day = 18 units/day (upper end of range)

The basal insulin dose would be 40-50% of the TDD, which would be:

• 9 units/day x 0.4 = 3.6 units/day (lower end of range)
• 9 units/day x 0.5 = 4.5 units/day (upper end of range)
• 18 units/day x 0.4 = 7.2 units/day (lower end of range)
• 18 units/day x 0.5 = 9 units/day (upper end of range)

The bolus insulin dose would be the remaining 50-60% of the TDD, which would be:

• 9 units/day x 0.6 = 5.4 units/day (lower end of range)
• 9 units/day x 0.5 = 4.5 units/day (upper end of range)
• 18 units/day x 0.6 = 10.8 units/day (lower end of range)
• 18 units/day x 0.5 = 9 units/day (upper end of range)

Adjustment of Insulin Doses

The basal and bolus insulin doses would need to be adjusted based on the child's blood glucose levels, dietary habits, and physical activity level. The correction factor (CF) and insulin-to-carbohydrate ratio (ICR) would be used to make these adjustments 3.

• The CF would be used to adjust the bolus insulin dose based on the child's blood glucose levels, with a common starting point being 100-200 mg/dL per unit of insulin.
• The ICR would be used to adjust the bolus insulin dose based on the child's dietary carbohydrate intake, with a common starting point being 1:10 to 1:20 (1 unit of insulin per 10-20 grams of carbohydrates).

It is essential to note that these are general guidelines, and the specific insulin regimen for this child should be determined by a healthcare professional, taking into account the child's individual needs and circumstances 6, 4, 7.