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

Abstract

The "500 rule" has been used extensively to find the insulin to carbohydrate ratio (ICR) for carbohydrate counting (CC). Duration of insulin action (DIA) is often recommended to be set to 4 hours. Data are lacking on validating these routines in young children. ICR was calculated by dividing carbohydrate grams by insulin units. Insulin sensitivity factor (ISF) was defined by the 100 rule (100 divided by total daily insulin dose [TDD]). DIA was set to 3 hours. ICR, ISF, and DIA were adjusted continuously. Data for this retrospective analysis were taken from pump downloads at a routine visit. ICR and ISF were recalculated to rules (ICR/ISF multiplied by TDD). A total of 21 prepubertal children aged 7.0 ± 2.3 (mean ± SD), range 2-10 years, with diabetes duration 3.0 ± 1.9, range 0.5-7.7 years, used the pump bolus calculator for CC. HbA1c IFCC (NGSP) was 53 ± 6 mmol/mol (7.0 ± 0.5%). None had experienced severe hypoglycemia (unconsciousness/seizures) since diabetes diagnosis. TDD was 0.7 ± 0.1 U/kg/24 h (range 0.5-1.0), and the percentage basal insulin 38 ± 11%. Median breakfast rule was 211 (Q, quartiles 162;310), and for other meals 434 (Q 301;496). Median ISF rule was 113 (Q 100;128) in the morning, and 120 (Q 104;134) during the rest of the day. DIA was 2.6 ± 0.5 h (range 2-3) and target BG 5.3 ± 0.4 mmol/l (range 5.0-6.0). Prepubertal children seem to need more bolus insulin for meals than calculated from the 500 rule, especially at breakfast, but less insulin for corrections than calculated from the 100 rule. Two to 3 hours seems to be the appropriate range for DIA in this age group.