Effect of Insulin Dilution on Lowering Glycemic Variability in Pump-Treated Young Children with Inadequately Controlled Type 1 Diabetes

Background: We investigated whether in young children with inadequately controlled type 1 diabetes and technical problems with continuous subcutaneous infusion of insulin at 100 units/mL the switch to insulin diluted to 10 units/mL (U10) can limit technical problems and improve glycemic control. Subjects and Methods: Diluted U10 insulin was started in three children 3.8, 3.2, and 1.3 years old with a hemoglobin A1c (HbA1c) level (mean +/- SD) of 8.1 +/- 0.17% (65 +/- 1.7 mmol/mol) and insulin dose of 8.80 +/- 2.93 units/day. Patients were evaluated with continuous glucose monitoring (iPro (TM) 2; Medtronic Minimed, Northridge, CA) and a quality of life questionnaire (PedsQL (TM); www.pedsql.org/) and surveyed for pump-related problems at baseline and after 3 and 9 months of U10 insulin therapy. Results: Continuous glucose monitoring records showed that glycemic variability assessed by SD and M100 decreased significantly (P=0.0085 and P=0.0482, respectively). HbA1c levels dropped to 7.3 +/- 1.00% (56 +/- 11.0 mmol/mol) after 3 months and to 6.7 +/- 0.55% (50 +/- 6.1 mmol/mol) after 9 months (P=0.12). Technical difficulties were minimized. Conclusions: These results suggest that the use of U10 insulin decreases glycemic variability and improves hampered pump therapy in young children with inadequately controlled type 1 diabetes.