Insulin (various)

How it works

Replaces or supplements endogenous insulin, promoting cellular glucose uptake, hepatic glycogen synthesis and suppression of gluconeogenesis and lipolysis to lower blood glucose.

Prescribing in practice

• Hypoglycaemia is the principal hazard; ensure rapid-acting glucose and a treatment plan are always available and that the family can recognise and manage it.
• Different insulin types and brands are not interchangeable, so specify the exact preparation and device and avoid inadvertent substitution.
• Match insulin type, timing and dose to carbohydrate intake and activity, adjusting during illness using sick-day rules and a children's formulary/local diabetes protocol.

Monitoring

Monitor capillary or continuous glucose, HbA1c, injection or infusion sites and growth, with ketone checking during illness or hyperglycaemia.

Counselling the patient

• Teach the child and family to recognise and treat hypoglycaemia and to always carry fast-acting glucose.
• Rotate injection sites to prevent lipohypertrophy, which alters insulin absorption.
• Follow sick-day rules, continue insulin during illness and check ketones when unwell or glucose is high.

Evidence & guidelines

Insulin replacement is the cornerstone of paediatric type 1 diabetes management per NICE guidance (NG18).