From Manchester, UK:
Our newly diagnosed 4 year old daughter seems to get quicker onsets and shorter durations of both Actrapid [Regular insulin] and Insulatard [NPH insulin] than the manufacturers state. How much is known about the timescales of action of insulin in very young children?
Also, as a newly diagnosed child, should she be screened for other autoimmune disease. And should her 13 and 15 year old siblings be being checked?
Finally, is there any way of getting 0.25ml syringes in the UK, with half-unit markings?
This question was referred to several members of the Diabetes Team, who have each given an answer:
Answer from Dr. O'Brien:The answers to your questions, not necessarily in the order that you asked them are:
- I am sure that Terumo 0.25 ml.syringes are available in Britain and also the Bectin-Dickinson 0.3 ml. ones. Only the first one has 0.5 unit calibrations though. Probably any branch of Boots Chemists could tell you about availability; but if not you could get the information from The British Diabetic Association, 10 Queen Anne Street, London, WIM 0RD, Tel 0171-323-1531 or Fax 0171-637-3644.
- In the Diabetes Prevention Trial in the U.S. all participants are now being tested for anti-endomyseal antibodies for celiac syndrome and anti-21-hydroxylase antibodies for adrenal involvement. About 5% of new onset Type 1 diabetics are positive for the first antibody and about 2% for the second. It makes sense to have these tests run because anti-endomyseal antibodies almost invariably indicate changes in the intestinal mucosa and even if the person is asymptomatic there is a case for starting a gluten-free diet to avoid the small risk of a bowel lymphoma later in life. Having anti-21-hydoxylase antibodies does not require any immediate treatment; but it does forewarn if acute adrenal failure ever happens, which again is rare; but serious if not recognised.
- Older siblings should be tested and if positive (about a 3% chance) would be eligible to participate in the European Prevention Trial called ENDIT. Again you could track down the nearest laboratory through the British Diabetic Association.
- The duration of action of Actrapid and Insulatard can be variable at any age although it is consistent in the individual. In small children it is common for there to be an increased sensitivity to Actrapid and a correspondingly prompter action. With Insulatard a more rapid action is uncommon; but increased duration of effectiveness is quite often encountered. Individual idiosyncrasy is not important except that you have to adapt insulin dose and sometimes insulin type to it.
Additional Comment from Dr. Lebinger:Although I encourage people to participate in the ongoing Diabetes Prevention Trials, I would like to emphasize that these studies are still considered experimental and therefore participation is voluntary and the final decision must be made by you and your children. I suggest that you look into the details of the study and discuss them with your teenage sons before deciding to have them tested. (You might also be eligible for participation yourself depending on your age and general health).
Remember, if your child tests positive, you will have a 50% chance of being offered the "preventive treatment" - in Europe nicotinamide, and a 50% chance of being given a placebo.
Original posting 25 Feb 97
Last Updated: Tuesday April 06, 2010 15:08:52
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