Initial insulin therapy in children and adolescents with type 1 diabetes mellitus.
OBJECTIVE
The aim of the study was to define parameters that influence the initial insulin dosage in young subjects with type 1 diabetes regarding the amount of daily insulin, the ratios of basal and prandial insulin, and the insulin/carbohydrate ratios.


METHODS
We used a computer-based registry (with prospectively collected data) in Germany and Austria, a software for the management and data documentation of diabetic patients (DPV), to analyze the initial insulin therapy in 2247 children with newly diagnosed type 1 diabetes to identify factors that influence diabetes therapy within the first 10 d.


RESULTS
For both genders, glucosylated hemoglobin A1c (HbA1c), blood pH at diabetes onset, and pubertal status are the major factors determining the initial insulin dosage calculated as the amount of daily insulin per kilogram body weight (kg), the basal and prandial insulin dose per kilogram, and day and the insulin/carbohydrate ratios for meals. The frequency of hypoglycemia correlated with increasing quotient of applied to calculated insulin dosage.


CONCLUSIONS
The predictive factors of insulin requirement may exert beneficial effects on the assessment and adjustment of insulin therapy in young diabetic subjects at disease onset. On the basis of a multiple, linear regression, we suggest a formula to calculate the initial insulin therapy.
Weitzel
Dieter
D
German Clinic for Diagnostic, Children's and Adolescent's Outpatient Centre, Wiesbaden, Germany.
Weitzela
Dieter
D
Pfeffer
Ulla
U
Pfeffera
Ulla
U
Dost
Axel
A
Herbst
Antje
A
Herbstc
Antje
A
Knerr
Ina
I
Holl
Reinhard
R
D000293:Adolescent; D001317:Austria; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D020360:Neoadjuvant Therapy; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin