Initial dosing of insulin for a child with newly diagnosed type 1 diabetes using multiple daily injections

* Total daily insulin dose for children with newly diagnosed type 1 diabetes mellitus generally is between 0.3 and 1 units/kg. Prepubertal children require doses on the lower end of this range (0.3 to 0.7 units/kg/day). Higher doses (eg, >0.7 to 1 units/kg/day) are needed for patients with insulin resistance (eg, those in puberty, recovering from ketoacidosis, or being treated with glucocorticoids, and some with obesity). These doses are titrated up or down as needed depending on the patient's response.

¶ For most patients, the basal insulin requirement is approximately 50% of the estimated total daily insulin dose. The proportion may be lower (eg, 40% of the total daily dose) in children who are in a rapid growth phase. The proportion may be higher (eg, 60% of the total daily dose) for those on a low-carbohydrate diet.

Δ The total mealtime insulin dose may vary each day, depending on food intake and any dose corrections for blood glucose above the target range.

◊ Basal insulin is usually given once daily and usually in the evening. However, some children do better with 2 divided doses, eg, those who tend to have nocturnal hypoglycemia. Insulin degludec may also be used; it has a longer duration of action but is still given once daily.

§ The dose of mealtime insulin depends on several factors:

• Anticipated amount of carbohydrates ("carbs") that will be ingested and the patient's individual insulin dose per gram of carbohydrate, expressed as their carbohydrate ratio. A low-carbohydrate snack may not require an insulin bolus.
• The measured mealtime blood glucose and mealtime target (typically blood glucose 100 to 120 mg/dL) and individual "correction dose."

Refer to UpToDate topic on insulin therapy for details on these calculations and other factors that may affect insulin dosing.