Treatment Options for Insulin-Sensitive Children

A diabetes educator discusses diluted insulin, which can help stave off blood sugar swings.



Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q: Help! My child is really sensitive to small doses of insulin. Even half-units sometimes bring her down way too much. Is there a way to give doses in increments smaller than we can do with pens and syringes?

A: For years, diabetes educators and clinicians have been asking the industry to develop pens and syringes that allow for micro-dosing of insulin for anyone who is very sensitive to their insulin. So far, no dice. They claim there just isn’t enough of a market to make it worth their while.

Luckily, you do have some good options. Rapid-acting insulin can be diluted before it is drawn up and injected. Both Novo Nordisk and Eli Lilly offer diluent (a sterile, pH-compatible fluid) that can be mixed with rapid insulin to reduce its concentration. For example, mixing insulin and diluent at a 50/50 ratio would produce insulin that is 50% of its normal concentration (called U-50). Giving a 1/2-unit of this mixture would be the same as giving a 1/4-unit of insulin (U-25). Mixing 9 parts diluent with 1 part insulin would produce insulin that is 10% of the normal concentration (U-10), or 1/10 of a unit of actual insulin.

It’s important to note that you should not attempt this without your healthcare team’s approval. Also, you shouldn’t dilute the insulin with anything but the diluents provided by insulin manufacturers. Diluent must be ordered through a pharmacy and the process requires careful instruction for proper mixing and use.

Another option which might be easier is to switch from injections to an insulin pump. Today’s pumps allow delivery of insulin in tenths of twentieths of a unit with extreme precision. This would enhance your ability to microdose for meals and when correcting high readings.

Have a Question? Insulin-Quiring Minds is a free service of the clinical team at Integrated Diabetes Services LLC. Submit your questions to jennifer@integrateddiabetes.com. All questions will be answered, and yours may be chosen to appear in Insulin Nation.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to integrateddiabetes.com or write info@integrateddiabetes.com

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Jennifer Smith holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a registered and licensed dietitian, certified diabetes educator, and certified trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She has lived with Type 1 diabetes since she was a child,and thus has first-hand knowledge of the day-to-day events that affect diabetes management.