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Question:

From a physician in Brazil:

I am caring for a pre-term child, 32 weeks, female, with persistent hyperglycemia (neonatal diabetes). She is now 3 weeks old. She isn't using drugs other than insulin. What is the best treatment? Insulin must be done SC or IV? And what about the usual dosage?

Answer:

Neonatal Diabetes is a very rare condition: it can be transient, lasting a few weeks, and some of these babies show a chromosomal abnormality. It can also be permanent and due either to insufficient development of the islet cells or to a complete failure of these cells to develop. In these cases there may be a related dysgenesis of the exocrine part of the pancreas as well, a complication that needs additional treatment in order to sustain normal nutrition.

Control of the hyperglycemia requires insulin and without more information on this infant's weight, food intake and blood sugar levels, I would not want to be specific about dose beyond cautioning against the risk of hypoglycemia. But to minimize the problems of giving very small amounts of insulin I would try initially to keep blood sugars in the 80 to 180 mg/dl (4.5 to 10 mmol/l) range using a single dose of a long acting insulin like Ultralente or NPH with a three hourly x7 feeding regimen with a total dose not exceeding 0.8 units/kg body weight /day. Clearly this infant needs to be in an intensive care situation, if at all possible, where blood sugars can be monitored closely to begin with and there is expert nursing care.

DO'B

Original posting 21 Sep 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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