title: Basal and bolus insulin requirements in children, adolescents, and young adults with type 1 diabetes mellitus on continuous subcutaneous insulin infusion (CSII): effects of age and puberty.
abstract: OBJECTIVE
  Guidelines for insulin dosing, including the insulin to carbohydrate ratio (I/C), insulin sensitivity factor (ISF), and basal/bolus ratio guidelines, have been well established for adults with type 1 diabetes mellitus (T1DM). However, clinical experience suggests that these guidelines are not appropriate for children. The purpose of this study was to determine the continuous subcutaneous insulin infusion (CSII) settings in children with T1DM at different ages and stages of puberty.
  
  
  METHODS
  A total of 154 patients data between the ages of 3 and 21 years with well-controlled T1DM according to American Diabetes Association guidelines were reviewed. Only patients on CSII who were not in the honeymoon period were included.
  
  
  RESULTS
  Patients were divided into 8 groups according to age, gender, and/or pubertal stage. Insulin requirements increased with puberty in both sexes (0.69, 0.97, and 0.90 U/kg/day in children <7 years of age, midpubertal girls, and late-pubertal boys, respectively). Basal insulin requirement was lowest in the youngest group (34%; P<.01). The youngest group had the lowest I/C prediction factor (PF) (mean, 315.7 ± 79.4; P<.01 with all groups), and the ISF-PF was higher than that of the oldest group (mean, 2,588.3 ± 1,101.8; P<.01).
  
  
  CONCLUSIONS
  CSII dose calculations vary with age and pubertal status in children with T1DM. These differences must be considered when calculating CSII dosing, especially for younger children.
authors.affiliation: Spectrum Health Medical Group, Pediatric Endocrinology and Diabetes Clinic, Helen DeVos Children's Hospital.
authors.forename: Ayse Pinar
authors.initials: AP
authors.lastname: Cemeroglu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Thomas
authors.forename: Luke T Vande
authors.initials: LT
authors.lastname: Zande
authors.forename: Nga T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wood
authors.forename: Lora
authors.initials: L
authors.lastname: Kleis
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D011627:Puberty; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007328:Insulin