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From Christchurch, New Zealand:

My nine old daughter has had type one diabetes for three years, and I was once told that as a general rule children require one unit of insulin per kilogram of body weight per day. I know this is only a general rule, but my daughter seems to require double this amount and much more than most other children I know. At present her insulin requirements are 30 units Penmix 10 Protaphane/Actrapid in am, 4 units Humalog at lunchtime, and 8 units Penmix 10 at tea.

Why does she seem to need so much insulin? Do you think would an insulin pump would help?


There are a number of possible explanations for your daughter's relatively high insulin requirements. First, you might be using insulin that has been open over a month old and injecting into exactly the same area every day. Secondly, your daughter may have begun her pubertal growth spurt. Whilst age nine might seem a little young, it is not these days, especially if you yourself came early to puberty.

Other much less common forms of insulin resistance include the possibility that she might actually have type 2 diabetes, but a positive antibody test at onset would disprove that.


Additional comments from Dr. David Schwartz:

I agree that the amount of insulin your child requires does seem generous. Are her hemoglobin A1c levels in a good range with this amount? If so, then perhaps there is no medical reason to change.

Some children, even those with type 1 diabetes, have a degree of underlying insulin resistance (as seen in type 2 diabetes). For such patients, an insulin sensitizer or a medication such as metformin may be considered in addition to insulin.

Puberty can also antagonize the effects of insulin prompting larger doses, but frankly, in my experience, larger amounts of insulin than expected more often relates to meal planning and food consumption that has gone awry to a degree.

An insulin pump may certainly be helpful but requires excellent meal planning and carbohydrate counting skills in order to properly dose the extra insulin required with every meal and snack.


Additional comments from Dr. Stuart Brink:

Sounds like a lot of insulin. If she is not overweight, this would be very unusual for typical type diabetes in the prepubertal years. We don't use very much premixed insulin so this may also be contributing to the problem. I'd go back and discus with your pediatric diabetologist and staff to see if they have some idea when looking at food, activity, blood glucose readings as well as insulin doses.


Original posting 5 Jun 2003
Posted to Daily Care


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Last Updated: Tuesday April 06, 2010 15:09:46
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