- Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
- 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
- Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
- May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
- Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins (Novolog, Novorapid)
- Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
- Notes
- Rapid Insulin (Novolog/Novorapid) may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
- Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
- Safety and efficacy in pediatric patients <2 yrs has not been established
- Continuous subcutaneous infusion pump
- Avoid mixing or diluting when using in an external insulin infusion pump
- Intravenous infusion
- Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
- Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
- As with all IV uses of insulin; carefully monitor glycemic response and potassium levels
Diabetes Mellitus-Children >2 yrs
- Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
- 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
- Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
- May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
- Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins (Novolog, Novorapid)
- Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
- Notes
- Rapid Insulin (Novolog/Novorapid) may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
- Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
- Safety and efficacy in pediatric patients <2 yrs has not been established
- Continuous subcutaneous infusion pump
- Avoid mixing or diluting when using in an external insulin infusion pump
- Intravenous infusion
- Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
- Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
- As with all IV uses of insulin; carefully monitor glycemic response and potassium levels
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