Toddlers’ choice: Yo-Yoing diabetes control or deci-unit insulin dosing?

Abstract

While the incidence of toddlers' diabetes is soaring, their mainstay insulins were withdrawn, namely the weak 10% or 20% insulin mixtures (WIM), which were injected only once or twice daily�� Consequently, toddlers are coerced to use an insulin pump,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��

Toddlers' diabetes: the lost insulin drop and SemiPens vs. DeciPen

“…This manufacturer‐produced DeciPen would have all the advantages of dilution and accuracy, and allow using child‐friendly devices: Microfine ® , PenMate ® , and Autocover ® . This option is not yet available, despite justified demand . It would be a significant addition to the youngsters' diabetes armamentaria, especially where pump therapy is unavailable or less affordable.…”

“…If a standard drop dribbles, the pen would deliver 0.89–0.36 = 0.53 U—farther away from 1 U than the syringe, a greater syringe's accuracy in small doses. From this and prior work , further SemiPen‐syringes research is needed to assess: low dose accuracy, injection time, psychological effects, dribbling, skin leakage, and dosing precision‐flexibility.…”

Half-Unit Insulin Pens: Disease Management in Patients With Diabetes Who Are Sensitive to Insulin

“…U20 insulin preparations (20 units/mL) facilitated insulin dosing to 0.2U and were termed "toddler-friendly" insulins because of the small dose increments that could be administered. 55 Since the standardization of U100 insulin preparations (100 units/mL), U20 (20 units/mL) have been withdrawn, leaving a gap in the market for insulin dosing accuracy below 1U. 55 HUPs aid in addressing the lack of small dosing increments by enabling 0.5U dosing increments.…”

“…55 Since the standardization of U100 insulin preparations (100 units/mL), U20 (20 units/mL) have been withdrawn, leaving a gap in the market for insulin dosing accuracy below 1U. 55 HUPs aid in addressing the lack of small dosing increments by enabling 0.5U dosing increments. Currently, precision and accuracy beyond 0.5U can only be achieved through the use of insulin pumps or by insulin dilution.…”

“…Currently, precision and accuracy beyond 0.5U can only be achieved through the use of insulin pumps or by insulin dilution. 55 However, these approaches have drawbacks, because the availability of pumps is limited and insulin dilution necessitates the use of a syringe, 55 introducing the risk of contamination if a patient mixes their own parenteral medications. Pens delivering more accurate insulin dosing with 0.1U precision could benefit certain patient populations, such as insulin-sensitive patients using carbohydrate counting who may only require very low doses of insulin per day.…”