ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

A randomized crossover study of the efficacy and safety of switching from insulin glargine to insulin degludec in children with type 1 diabetes

“…The possible reasons for this difference in results of the present pediatric study and those of our previous study of young adults include the following: first, the PG profiles in young children might be more strongly affected by bolus insulin regimens than by basal insulin regimens, as the amounts of food consumption and physical exercise are much less predictable in children than in adults. In general, it is difficult to adjust the bolus insulin doses to achieve optimal post-prandial glycemia in children with type 1 diabetes, even when using the carbohydrate counting method [1]. Accordingly, it is important to adjust the bolus insulin doses using adequate insulin preparations in order to achieve optimal glycemic control in pediatric patients [20].…”

“…As mentioned above, basal-bolus regimens frequently comprise an Ra as a bolus regimen, and a La, which has a longer action time as compared with neutral protamine Hagedorn (NPH) insulin, as a basal regimen [1]. Several reports have indicated that most patients using insulin glargine (IGlar) must administer more than twice-daily injections to cover their 24-hour basal insulin supplementation [6][7][8].…”

“…This basal-bolus concept allows to adjust these insulin doses according to each patient's eating habits and lifestyles [1].…”

Insulin glulisine for continuous subcutaneous insulin infusion in pediatric type 1 diabetes

“…Continuous s.c. insulin infusion (CSII) is an alternative to multiple daily injections of insulin (MDI) if hemoglobin A1c (HbA1c) is continually above the individual's target and if hypoglycemia is a major problem or quality of life needs to be improved . Recently, the use of CSII has been increasing worldwide, particularly in young children, because it can mimic near‐normal physiological insulin secretion patterns despite the erratic lifestyle and eating habits of children, and it is proving acceptable and successful for glycemic control in most children and adolescents with type 1 diabetes …”

“…A rapid‐acting insulin analogue (RA) is most often used for CSII, because the rapid action of an RA not only reduces post‐prandial hyperglycemia but also nocturnal hypoglycemia . Three RA, insulin aspart (ASP), insulin lispro (LIS), and insulin glulisine (GLU), are currently available for use in pediatric patients.…”