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Question:

From America OnLine:

I have a 7 week old infant just diagnosed with Type 1 diabetes. Her initial dose of insulin was very clear: one unit of NPH insulin daily. Her latest doctor ordered a dose of insulin that none of my medical friends have heard of -- the order is to dilute the U-100 insulin into U-10 and to give a volume of 20 units in a U-100 syringe. I am assuming that this is an equivalent of 2 units daily but given in a larger volume of fluid. Is there a reason to give this more dilute? I'm used to infants getting less fluid volume, not more. I'm guessing that there may be an absorption component involved. I do plan on discussing this with the doctor but it's Friday night and he is unavailable until Monday morning. The nurses do not know his reasoning and I might add that this is the youngest child they've ever taken care with diabetes. Any insights into this will be appreciated. Thanks.

Answer:

It may have been recommended to dilute the insulin to slow down its absorption; this concept used to be used extensively, but we don't use it as much anymore in our practice. The problem is that diluted insulin loses its potency after a few weeks.

If your child is not under the care of an experienced pediatric diabetes team, then get a referral immediately. Children's diabetes programs are used to dealing with the specialized problems of infants.

SS

Additional Comments from Dr. Lebinger:

You are correct that when you draw up 20 "line's" on an insulin syringe of insulin that has been diluted to 1/10th strength you are drawing up the equivalent of 2 units of undiluted insulin. The reason to dilute the insulin is to facilitate making very small changes in insulin dose as necessary (less than 1 unit per change) Infants require much smaller doses of insulin than adults or older children and you may find it necessary to make very small changes in dosage at a time, perhaps 1/10th or even 1/20th of a unit at a time at this age. You can only do this accurately with diluted insulin.

For instance, if you would want to change you child's dose from 1.0 to 1.1 unit, if you use 1/10 strength insulin, instead of drawing up 1 unit of undiluted insulin, you would draw up 10 "lines". of the 1/10th strength insulin. To draw up 1.1 unit of insulin, you would draw up "11" lines using 1/10th strength insulin. As your child gets bigger and needs more insulin, you may need to change to a less dilute preparation so the volume is not uncomfortably large.

1/10th strength insulin is called U10 as opposed to convention undiluted insulin which is U100. U100 insulin has 100 units per CC. U10 has 10 units per CC. One "unit" of undiluted insulin takes up 0.01 CC on an insulin syringe.

If you have any questions with insulin dose, you should not hesitate to ask your doctor to explain it to you when he or she recommends the dose. It is important to have a Pediatric Endocrinologist taking care of your baby.

TGL

Additional Comments from Jeff Hitchcock, the Editor:

We used diluted regular with our daughter Marissa until she was seven years old, often giving her 1/4 of a unit of regular before dinner. There was no way to give 1/4 unit accurately without diluting it. And yes, diluted regular is only good for a few weeks, but the diluent and empty vials are free from Lilly, so it didn't cost us anything to make it (well, it cost one syringe).

JSH

Original posting 23 Aug 96

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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