Insulin Doses before and One Year after Pump Start: Children Have a Reversed Dawn Phenomenon

Abstract

Abbreviations: (HbA1c) hemoglobin A1c, (MDI) multiple daily injections, (PG) plasma glucose, (REM) rapid eye movement, (TDD) total daily dose Keywords: basal rate, bolus doses, children, dawn phenomenon, diabetes, insulin pump Abstract Objective:We aimed to investigate the basal rate and bolus doses in children and adolescents at the start of insulin pump therapy and after 1 year of use. Patients and Methods:Case records from 29 children and adolescents were examined. All pumps were started with rapid-acting insulin (Humalog). Patients were aged 13.1 ± 3.9 years, with a diabetes duration of 5.4 ± 4.1 years at pump start. Sixteen pumps were started for high hemoglobin A1c (HbA1c; >8.8%, 73 mmol/mol) and 13 for other reasons. Results:Basal rates declined in both groups by 20% at 3 days after pump start. The bolus doses were reduced by 25-30% when the indication was high HbA1c and by 15% in the others. After 1 year, there was a significant difference in the basal rate between age groups. The 3-9-year-old age group had higher basal rates during the late evening (10:00 PM-12:00 AM), while the 15-21-year-old age group had higher basal rates in the early morning (3:00 AM-7:00 AM). Conclusions:Insulin doses are reduced considerably when starting with a pump in pediatric practice. Younger children needed higher basal rates late in the evening (reversed dawn phenomenon), while older teenagers seem to need an increase in the morning, which may correspond to a true dawn phenomenon.

Analysis of insulin pump settings in children and adolescents with type 1 diabetes mellitus

“…Total daily insulin dose and basal insulin dose increased with age as expected. As with previous studies that investigated the circadian profiles of basal insulin between different age groups , we showed an increase in basal insulin requirement in adolescents during the early morning hours, corresponding to the dawn phenomenon as well as an increase in basal insulin requirement in preschool children during the late evening, corresponding to the dusk (or reverse dawn) phenomenon. Reasons for these phenomena remain unclear, although some researchers have proposed that the differences in growth hormone and cortisol secretion patterns between children and adolescents may be the cause for predawn insulin resistance .…”

Bolus Calculator Settings in Well-Controlled Prepubertal Children Using Insulin Pumps Are Characterized by Low Insulin to Carbohydrate Ratios and Short Duration of Insulin Action Time

“…The lower ICR in the morning reflects the well-known morning insulin resistance, while the lower ICR in the evening reflects the reversed dawn phenomenon often found in young children. 23,24 Calculating ICR based on BW gives too low numbers, that is, would result in even higher bolus doses. The glycemic control in this study compares favorably with published data where the mean HbA1c in 4-to 10-year-old children was 7.9% (63 mmol/mol).…”

Managing diabetes in preschool children

“…The low requirement of insulin and tendency toward low glucose levels are often most obvious during the night and especially between 3 and 6 am . Preschool children often need much more insulin late in the evening between 9 pm and 12 midnight . This creates typical patterns when programming the basal rates of an insulin pump used by a preschool child.…”