Background: While childhood diabetes incidence is rising, especially in toddlers, once or twice-daily toddler-friendly insulin mixtures were withdrawn, imposing four to five miniscule injections, on needle-phobic toddlers. Although more injections may mean more needle-dribbling, such potential dose-loss is unstudied.Objective: Study insulin loss in toddlers' dose range if one-drop dribbled during injection from half-unit pens (SemiPens). Drop-loss is assessed relative to current insulin dose adjustment, and if significant, propose solutions.Methods: The SemiPens, New HumaPen Luxura HD® (HumaPen) and NovoPen Junior® (NovoPen), with 31G-5mm BD-MicroFine needles were used to study drop size or dose-fraction lost if one drop dribbled in dose range 0.5-10 units.Results: HumaPen and NovoPen produced sizable drops mean standard deviation (SD) 0.30 (0.05) and 0.36 (0.06) units/drop (p<0.001). This constituted progressively increasing proportion of the toddlers' doses, 10-fold higher percentage from 6 to 60% or 7.2 to 72%, as the dose gets smaller from 5 to 0.5 units.Discussion: Insulin dose-adjustments are usually done therapeutically within 5-20% dose-changes, while one-step reduction by >20% is hardly required.Therefore, the unintentional dosing change if a drop dribbles is clinically important particularly on using multiple doses below 6 units, compared with fewer larger daily injections. We propose using U20 insulin in disposable SemiPens to make DeciPen, with fivefold-reduction in insulin loss if a drop is lost through dribbling or skin-leak.Conclusion: The one-drop insulin loss is statistically significant, clinically important, and potentiates glycemic variability. Disposable DeciPen may minimize insulin dribbling and leaking and fivefold improve dose accuracy and precision; and ensure reproducibility without prolonging injection time.
While the incidence of toddlers' diabetes is soaring, their mainstay insulins were withdrawn, namely the weak 10% or 20% insulin mixtures (WIM), which were injected only once or twice daily�� Consequently, toddlers are coerced to use an insulin pump, multi-dose insulin regime (Mu�IR), mix or dilute insulins�� This paper highlights the difficulties and proposes a simple solution�� While an insulin pump is the best available option, it is not readily available for everyone�� Mixing insulins is not sufficiently precise in small doses. Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections, it, like insulin mixing, deprives children from using the pen and related child-friendly accessories�� In Mu�IR, we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM�� Thus, on using a half unit (½ unit) insulin pen, a dose of 0��5, 1, 1��5 and 2 units are adjusted in steps of 100%, 50%, 33% or 25%; unlike the advisable 5%-20%�� This does not easily match the tiny erratic meals of grazing toddlers�� Maternal anxiety peaks on watching yo-yoing glycemia�� Carers have to accept either persistently high sugar or wild fluctuation. The risks of such poor glycemic pattern are increasingly recognized�� Using insulin U20 in a ½unit disposable pen allows deci-unit dosing, with 5%-20% dose-tuning, greater accuracy on delivering small doses and reduction of dose variability from dribbling�� �eci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers�� �e-ci-unit pen materializes the Human Rights of Children, a safer and effective treatment��
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