The management program for any child with diabetes mellitus should involve flexibility and 24 hour insulin coverage and should be able to fit into the child’s life-style. The insulin treatment should be determined by the recognition that the effective duration of action of insulin in children may be somewhat different from that in adults. The effective action of insulin is described as the effect of a certain amount of insulin in lowering the blood glucose level over a period of time. Ideally the blood glucose level is maintained at less than 140mg.dL and n lower than 60mg/dL during the time of specific action of the insulin, based on past information regarding the duration of action of the intermediate-acting insulin is 24 hours or more, but in insulin-dependent children it does not appear to be the case. The duration of effective action for intermediate-acting insulin has been found to be 12 to 14 hours. Lente insulin is the longest acting of the intermediate-acting insulin, but it even lasts only for 14 to 16 hours.
In working with these insulin, it is wise to remember that lente insulin is 30% semilente and 70% ultralente. Lente insulin that mix with no other insulin other than regular derive their action from the size and number of crystals-small and numerous crystals= ultralente insulin. Pretamine zinc insulin (PZI) is seldom used today because of its very long duration of action and its very low tissue insulin levels, which may not saturate receptor sites on the cell membrane sufficiently well to effectively help the body utilize the glucose that may be present. The potential overlap of insulin action is unsuited for children, who are active one minute and very inactive the next. The balance that needs to be achieved between insulin, diet, and activity is most difficult when using this type of insulin. The intermediate-acting insulin (other than lente insulin) derive their delayed action from a protein tag. The most commonly used insulin are the intermediate-acting insulin, principally isophane, which are usually given in a single early morning dose combined with a small amount of short- acting insulin (usually regular).
