Intro: As T1D technology use expands for children down to age 2, fine tuning dosing has become easier. Traditional dosing formulas for insulin-carb ratios (ICR) and insulin sensitivity factor (ISF) are derived from older patients prior to intro of AID. We seek to determine how ICR and ISF differ between patients on AID v MDI, and demonstrate what dosing tuning formulas are used in a large pediatric clinic.
Methods: Retrospective data was collected on all T1D patients under age 7 years old at a tertiary care center’s diabetes clinic. 230 subjects were seen below age 7 in our clinic in the last 12 months (age 1.1 years to 6.8 years). Data was stratified by AID versus MDI use and by A1c. ICRs were grouped by meal. ICR from each time period was multiplied by TDD to determine a formula starting point for these patients. ISF was multiplied by total daily dose for ISF formulas.
Result: ICR is more aggressive for breakfast in all users, and even more so for those on MDI. ISF is more aggressive in MDI users. When divided by A1c, only breakfast ICR was significantly different (p<0.05). Of note, TBR was below 3% in both MDI and AID use; however it was significantly lower in AID use (TBR <70: 2.6% MDI vs 1.9% AID, p<0.05).
Conclusion: In young children with T1D on both MDI and AID at a large pediatric diabetes clinic, ICR is more aggressive than the often cited 450 or 400 rule in clinical settings among a large pool of providers. Conversely ISF is more conservative compared to 1800 rule in AID but not MDI use.
I. Tabatabai: None. G.P. Forlenza: Research Support; Abbott, Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; Insulet Corporation. Consultant; Insulet Corporation. Research Support; Medtronic. Advisory Panel; Medtronic. Research Support; Tandem Diabetes Care, Inc. Consultant; Tandem Diabetes Care, Inc.
