Initial dosing of insulin for a child with newly diagnosed type 1 diabetes using multiple daily injections

* Total daily insulin dose for children with newly diagnosed type 1 diabetes mellitus generally is between 0.3 and 1 units/kg. Prepubertal children require doses on the lower end of this range (0.3 to 0.7 units/kg/day). Higher doses (eg, 0.7 to 1 units/kg/day) are needed in pubertal children or patients in ketoacidosis or on corticosteroids and, sometimes, for those with obesity. These doses are titrated up or down as needed depending on the patient's response.
¶ For most patients, the basal insulin requirement is approximately 50% of the estimated total daily insulin dose. The proportion may be lower (eg, 40% of the total daily dose) in children who are in a rapid growth phase. The proportion may be higher (eg, 60% of the total daily dose) for those on a low-carbohydrate diet.
Δ The total prandial insulin dose may vary each day, depending on food intake and any dose corrections for blood glucose above the target range.
◊ Basal insulin is usually given once daily and usually in the evening. However, some children do better with 2 divided doses, eg, those who tend to have nocturnal hypoglycemia or when detemir insulin is used. Insulin degludec may also be used; it has a longer duration of action but is still given once daily.
§ The dose of prandial insulin depends on several factors:

• Anticipated amount of carbohydrates ("carbs") that will be ingested and the patient's individual insulin dose per gram of carbohydrate, expressed as their carbohydrate ratio. A low-carbohydrate snack may not require an insulin bolus.
• The measured preprandial blood glucose and preprandial target (typically blood glucose 100 to 120 mg/dL) and individual "correction dose."

Refer to UpToDate topic on insulin therapy for details on these calculations and other factors that may affect insulin dosing.