The insulin regimen

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Patients with type 1 diabetes and some with type 2 must receive insulin manually. Learn what an insulin regimen is and the different routines.

Key points

  • An insulin regimen is how much insulin your child gets (dosage) and how often they get it (frequency).
  • Depending on your child's needs there are different insulin regimens including multiple daily injections (MDI), three-times-a-day (TID) insulin routine, and twice-a-day (BID) insulin routine.

Patients with type 1 diabetes do not produce their own insulin, so they must receive it manually from an external source. Some patients with type 2 diabetes also need to be given insulin. Insulin can be administered using a pen, a syringe, or an insulin pump​.

What is an insulin regimen

At first, your diabete​s team will decide how much insulin your child gets (the dosage) and how often they get it (the frequency). This is the insulin regimen.

It can take a few days to a few weeks of fine-tuning to figure out exactly how much insulin your child needs. The amount of insulin depends on the amount of glucose (sugar) in the blood and the type of insulin used, as different formulations act on the body in different ways.

Because a child’s insulin needs are affected by their growth and development, appetite, physical activity, and stress or illness, no fixed dose will work forever. The dose will need to be adjusted frequently to provide the best blood sugar control.

Over time, blood sugar levels become stable and families gain more experience. Most parents and teens become quite skilled at taking charge and making decisions about changing their insulin doses. The diabetes team is always there for advice and backup.

Multiple daily injections (MDI)

Multiple daily insulin (MDI) is a proactive approach to diabetes management. It requires careful attention to meal planning and exercise, but allows for more flexible mealtimes and a bigger variety of activities. It requires matching insulin doses to carbohydrate intake and blood sugar levels, and follows your child’s specific insulin-to-carbohydrate ratio (I:C).

The I:C is the amount of carbohydrates (in grams) that one unit of rapid-acting insulin makes available to the body cells to consume. In other words, one unit of rapid-acting insulin “covers” for a specific amount of carbohydrates. The I:C is expressed as 1 unit: X grams of carbohydrates.

For example, an I:C of 1:10 means that 1 unit of insulin makes 10 grams of carbohydrates consumed. Each child has a specific I:C that your dietitian will help you determine.

This insulin regimen involves:

  • injecting a long-acting insulin once or twice daily as the basal dose (keeping baseline blood sugar levels stable), and
  • having further injections of rapid​-acting insulin before each meal (to regulate blood sugar levels after post-meal spikes). You can figure out what amount of insulin to inject by following your child’s I:C.

With four or five daily injections, MDI offers a steady stream of insulin throughout the day. As long as meals are spaced three to four hours apart so that doses of rapid-acting insulin are spaced three to four hours apart, this routine most closely matches how the pancreas would normally release insulin.

Challenges to using MDI

There are many reasons for using the basal/bolus approach in people with type 1 diabetes, including younger children. However, some special considerations must be given before implementing this routine:

  • Children require rapid-acting insulin before each meal; parents must ensure that another caregiver is available during working hours to administer the injection, whether at school or daycare or at home.
  • Some young children find needles very difficult; a routine requiring fewer injections per day might be preferable at first.
  • The risk of hypoglycemia​ is increased when a person tries to keep blood sugar levels close to normal; however, with practice and by using conservative targets, the risk of frequent or severe hypoglycemia is quite low.

Despite these challenges MDI is most commonly the standard of care for children, especially teens, with type 1 diabetes.

Three-times-a-day (TID) insulin routine

This involves giving insulin at three separate times of the day. Usually younger children are on this regimen because it does not require an insulin injection at lunchtime. Timing for insulin involves:

  • Intermediate-acting insulin and a rapid-acting insulin just before breakfast
  • a rapid insulin just before dinner
  • an intermediate or long-acting insulin just before bedtime.

Timing of meals and snacks for this regimen must be routine and consistent.

Twice-a-day (BID) insulin routine

Twice daily insulin routine involves administering two kinds of insulin:

  1. long-acting or intermediate-acting insulin
  2. and short acting insulin before breakfast and before dinner.

This is the least ideal routine because it can be challenging to achieve good blood sugar control. This routine is chosen for different reasons; for example, for infants and young children who go to sleep close to supper time, or for older children who may struggle with taking insulin.

Last updated: October 17th 2016