Preschoolers are not miniature adolescents: a comparison of insulin pump doses in two groups of children with type 1 diabetes mellitus

We analyzed glycemic control and insulin usage patterns of 14 preschoolers and 14 adolescents on continuous subcutaneous insulin infusion (CSII) matched for sex to determine how CSII therapy for type 1 diabetes mellitus (DM1) differs in preschoolers as compared to adolescents. Average hemoglobin A(1c) was lower in the adolescents. The percent of insulin delivered as the basal rate was the same in both groups; however, during the hours after midnight the preschoolers needed a much lower basal rate per kg body weight. There were also significant differences in insulin sensitivity and insulin/carbohydrate ratios. The number of basal rates, number of boluses, and percent of insulin administered as the basal rate were not different between groups. This is the first report of discrete differences in insulin usage patterns for preschoolers and adolescents on insulin pumps. Reasons for these dissimilarities include differences in hormone production, insulin absorption, frequency of food intake, and glycemic targets. Recognizing these variations is essential for safe and efficacious use of CSII in preschoolers with DM1.