Letters To The Editor
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World J Diabetes. Feb 15, 2012; 3(2): 35-37
Published online Feb 15, 2012. doi: 10.4239/wjd.v3.i2.35
Toddlers’ choice: Yo-Yoing diabetes control or deci-unit insulin dosing?
Sarah AA Abul-Ainine, Ahmad AA Abul-Ainine
Sarah AA Abul-Ainine, Foundation Year Doctor Royal Bolton Hospital, Bolton, BL4 0JR, England, United Kingdom
Ahmad AA Abul-Ainine, Department of Paediatric, Victoria Hospital, NHS Fife, Kirkcaldy, KY2 5AH, Scotland, United Kingdom
Author contributions: Both authors contributed equally to the paper; Abul-Ainine SAA and Abul-Ainine AAA contributed to the conception and design of this paper and the unpublished work and its interpretation; Abul-Ainine AAA wrote the first draft of the article; Abul-Ainine SAA revised it; both authors approved this final version.
Correspondence to: Dr. Ahmad AA Abul-Ainine, Consultant, Paediatrician, Department of Paediatric, Victoria Hospital, NHS Fife, Kirkcaldy, KY2 5AH, Scotland, United Kingdom. ainine@doctors.net.uk
Telephone: +44-1592-643355 Fax: +44-1592-641602
Received: July 14, 2011
Revised: December 24, 2011
Accepted: February 8, 2012
Published online: February 15, 2012
Abstract

While the incidence of toddlers’ diabetes is soaring, their mainstay insulins were withdrawn, namely the weak 10% or 20% insulin mixtures (WIM), which were injected only once or twice daily. Consequently, toddlers are coerced to use an insulin pump, multi-dose insulin regime (MuDIR), mix or dilute insulins. This paper highlights the difficulties and proposes a simple solution. While an insulin pump is the best available option, it is not readily available for everyone. Mixing insulins is not sufficiently precise in small doses. Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections, it, like insulin mixing, deprives children from using the pen and related child-friendly accessories. In MuDIR, we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM. Thus, on using a half unit (½unit) insulin pen, a dose of 0.5, 1, 1.5 and 2 units are adjusted in steps of 100%, 50%, 33% or 25%; unlike the advisable 5%-20%. This does not easily match the tiny erratic meals of grazing toddlers. Maternal anxiety peaks on watching yo-yoing glycemia. Carers have to accept either persistently high sugar or wild fluctuation. The risks of such poor glycemic pattern are increasingly recognized. Using insulin U20 in a ½unit disposable pen allows deci-unit dosing, with 5%-20% dose-tuning, greater accuracy on delivering small doses and reduction of dose variability from dribbling. Deci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers. Deci-unit pen materializes the Human Rights of Children, a safer and effective treatment.

Keywords: Child, Toddler, Diabetes, Insulin pen, Insulin mixture, Insulin dribbling, Deci-unit dosing, Deci-unit pen, Insulin U20, Glycemic control