What Should You Keep in Mind Before Initiating Insulin in Infants?

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Over the past few decades, there has been a 2% to 4% increase in the incidence of newborn diabetes. It is believed that this will only increase in the coming decades. Infants with Type 1 diabetes require insulin to control the level of blood sugar. However, giving insulin to infants is a tricky thing, as it can take some time to identify the right dose required. Complications like hyperinsulinism can lead to hypoglycemia (reduced sugar levels) and even cause seizures in newborns.

Insulin in Infants

Here are some factors to be considered when giving insulin to infants.

  1. Feeding patterns:  It is relatively easy to arrive at an optimal insulin dose for infants who feed on breast milk and formula. However, factors like refusal to feed, variable quantities of feeds, and prolonged naps at night can cause fluctuations in the blood sugar level of the infant. With infants who feed every 2 to 3 hours, blood sugar has to be monitored constantly to chalk out patterns for an optimal insulin dose. The doctor and parents will have to work together to arrive at an accurate dose. 
  2. Parental stress and anxiety: The detection of diabetes in infants along with management of the same can cause a lot of stress and anxiety to the parents. Learning more about the deficiency and blood sugar testing can help in managing the insulin intake for infants and becoming more open to the diagnosis. 
  3. Hypoglycemia: While insulin is being given to control the sugar levels, it may reduce it to a drastic level sometimes, leaving the infant with reduced sugar levels. This is a very severe complication and can cause seizures. The problem is worsened by the fact that infants cannot communicate and this often occurs at night during deep sleep.

Identifying the ideal dose of insulin for an infant: It can take some time to arrive at the right form and dose of insulin for an infant. But, in most cases, doctors prefer to give one daily dose of long-acting insulin. This is easier to give and both, the parents and the infant, are not distressed to a great level with multiple injections. Given the variable food intake and activity levels, this method often takes care of the insulin needs of an infant.

With advances in pump therapy, this is being looked at as the best bet for infants. This will allow a big dose to be delivered in one go and even stopped intermittently when they are sleeping to avoid hypoglycemia at night. This also reduces parental stress in terms of having to give multiple injections. It is not just clinical but also psychological and social with the entire family involved in caretaking.

As discussed above, different infants may benefit from different types of insulin dosage – multiple injections to one long-acting dose a day to a pump. Keeping the above factors in mind will assist in determining the correct method of giving insulin to an infant.

Dr. Karan Vats
Dr. Karan Vats is a pediatrician practicing at Vats Child Care Clinic, Sukh Vihar, Delhi. With over 6 years of experience, he is an expert in treating child-related health issues. He completed his MBBS from Safdarjung Hospital and MD in pediatrics from RML Hospital and has done specialised training in asthma and allergy. He is currently a member of IAP, DMC . He often conducts awareness camps in Najafgarh about child-related health issues.

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