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1. Patients with Type 1 diabetes will need both prandial insulin and basal insulin. Prandial insulin refers to short acting insulin that is given before ingestion of food. It helps to control the plasma glucose surge that occurs after digestion of carbohydrates in the intestines. Basal insulin refers to long acting or intermediate acting insulin that is given once or twice a day (morning and/or evening/night). Basal insulin helps to control plasma glucose between meals by acting on the glucose produced from the liver through glycogenolysis and gluconeogenesis.

2. To initiate insulin in patients with Type 1 diabetes, first check their body weight. Then calculate the total daily insulin dose needed. This is calculated as 0.5 units per kg body weight or 1 unit per kg body weight. It is always safer to initiate with a lower dose of insulin in any setting where close observation is not possible. This calculated total daily insulin dose is then divided as shown:

  • Half the total daily dose is given as prandial insulin, in divided doses before meals.
  • Half the total daily dose is given as basal insulin. This is given twice daily - morning and evening - with two-thirds being given in the morning and one-third in the evening.

A teenager weighing 40kg is to be initiated on insulin for Type 1 diabetes. His total daily insulin requirement, calculated at 0.5 units per kg, is 20 units. Therefore 10 units will be given as prandial insulin and 10 units will be given as basal insulin per day. Since he takes three main meals per day, he will be advised to start with 3 units of a short acting insulin (example Actrapid) given subcutaneously before each main meal. He must also take a long acting insulin (example Monotard or Insulatard) 6 units in the morning before breakfast and 4 units in the evening before dinner or at bedtime.

The two different insulins before breakfast (and before dinner) can be combined together in the same syringe.



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