1. Type I Diabetes Mellitus
MR 8/14/09
J.Chen

2. Management
Insulin
Monitoring
Nutrition
Exercise
Education

3. Insulin

4. Insulin Requirements Preadolescent-0.5-1 unit/kg/day
Adolescents units/kg/day
During honeymoon period-<0.5 units/kg/day

5. Starting an Insulin Regimen
Split mixed Regimen vs. Basal/Bolus Regimen

6. Split/Mixed Regimen 2-3 injections based on NPH 2/3 in AM, 1/3 in PM
2/3 NPH, 1/3 Regular/Rapid
More rapid/regular may be required in AM because of dawn phenomenon (nocturnal release of counter regulatory hormones-less insulin sensitivity in AM)
May require less during Honeymoon period

7. Split/Mixed Regimen

8. Monitoring Traditionally before meals, at bedtime, overnight
More often when ill or active
Acceptable range
Fasting/preprandial:
preschool: mg/dL
School age: mg/dL
Teenagers: mg/dL
Bedtime/overnight
Preschool: mg/dL
School age: mg/dL
Teenagers: mg/dL

9. Basal Bolus Regimen
Aims to achieve more physiologic insulin concentrations
Basal provides baseline or fasting insulin
Bolus provides coverage for food and correct for hyperglycemia
Basal rate given either through injection or via insulin pump

10. Basal/Bolus Regimen Basal requirement ~50% daily insulin need
Either long acting insulin or
Rapid acting insulin via pump
Bolus dose has 2 parts:
1. coverage for carbohydrates in meal
2. correction for blood glucose concentration outside of target range.

12. Monitoring HbA1c Urine or blood ketones should be monitored:
<6yr: %
6-12yr:<8%
13-19yr: <7.5%
Urine or blood ketones should be monitored:
Blood glucose elevated
Nausea
Vomiting
Feeling ill

13. Nutritional Management
Balanced Diet with adequate calories and nutrients for normal growth
50-55% carbohydrate calories, 20% protein calories, 30% fat calories
Most carb calories should be complex carbohydrates
Fat portion should be low in cholesterol and saturated fats

14. Nutritional Management
Split/Mixed-
timing important
Snacks
Treats should be allowed
Basal/Bolus
Flexibility in timing, amount, and content
Accurate carb counting and insulin dose calculation

15. Next TIME: DKA