While in the past there has been a tendency to try to minimise the number of injections per day, more children and teenagers are being treated with multiple daily injections or insulin pumps. This is to try to more closely match the body’s insulin needs similar to the way the pancreas works in people without diabetes. Many children now start on multiple injections or if started on 2 injections per day, soon evolve to 3 or 4 injections per day.
Twice daily insulin injections
This has been a commonly used combination in infants and children, who receive:
• Before breakfast: a mixture of short-acting insulin and long-acting insulin.
• Before main evening meal: a mixture of short-acting insulin and long-acting insulin.
This has been a commonly used combination in infants and children, who receive:
• Before breakfast: a mixture of short-acting insulin and long-acting insulin.
• Before main evening meal: a mixture of short-acting insulin and long-acting insulin.
The graph below shows how this combination is intended to work:
In many infants and young children who start on this combination, the short-acting insulin may become unnecessary after a few days or weeks and they may require only long-acting insulin, especially during the ‘honeymoon’ phase. Later on a combination will again be needed.
Three times daily injections
In this pattern of injections, children have:
• Before breakfast: A mixture of short-acting and long-acting insulin.
• Before afternoon tea or before the main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin or ultra-long acting insulin.
Three times daily injections
In this pattern of injections, children have:
• Before breakfast: A mixture of short-acting and long-acting insulin.
• Before afternoon tea or before the main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin or ultra-long acting insulin.
An increasing number of children are having injections three times a day because of advantages it can offer in diabetes control, and the ability to adjust injections for eating pattens, sport and exercise.
The graph below shows how a three times daily insulin combination works:
Four times daily injections (basal-bolus)
In this routine, often called the basal-bolus routine, people have:
• Before breakfast: Short-acting insulin.
• Before lunch: Short-acting insulin.
• Before main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin.
In this routine, often called the basal-bolus routine, people have:
• Before breakfast: Short-acting insulin.
• Before lunch: Short-acting insulin.
• Before main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin.
This offers very good flexibility for insulin adjustment, and is often helpful in diabetes control. Many children, teenagers and young adults now have four to five injections per day.
The graph below shows how a four times daily insulin combination works:
Other patterns of insulin dosage
Many other patterns of insulin dosage may be used, depending on individual needs. Those described above are in most common use.
Many other patterns of insulin dosage may be used, depending on individual needs. Those described above are in most common use.
Insulin Adjustment
Insulin requirements will vary according to your child’s activity, food intake and growth. For this reason it’s important to understand how to adjust insulin. Your educator will advise you on how to do this.
Insulin requirements will vary according to your child’s activity, food intake and growth. For this reason it’s important to understand how to adjust insulin. Your educator will advise you on how to do this.
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