Insulin dosing when converting from multiple daily injections to insulin pump therapy for a child with type 1 diabetes

MDI: multiple daily injections.
* To convert total daily insulin on MDI to pump:

• Total daily insulin on MDI = Basal insulin (glargine, detemir, or degludec) + Total prandial insulin (rapid-acting or short-acting insulin), averaged over 2 to 4 weeks.
• Total daily insulin dose to be used for the pump = 80 to 100% of the total daily insulin on MDI, depending on glycemic control (lower when glycemic control is excellent).

¶ For most patients, the daily basal insulin requirement is approximately 50% of the estimated total daily insulin dose calculated for the pump. The proportion may be lower (eg, 40% of the total daily dose) in children who are in a rapid growth phase or higher (eg, 60% of the total daily dose) in a patient 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.
◊ 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.