What you should know about insulin use - Children's Edition

Everyone is familiar with insulin, which is used to treat diabetes. Insulin was first discovered by Canadians FG Banting and CH Best in 1921. It has been exactly 100 years since then, and it has saved countless diabetic patients. With the improvement of our living standards, the number of children with diabetes has increased year by year in recent years. So what should we know about the use of insulin in children?

1. Do all children with diabetes need to use insulin treatment?

Diabetes in childhood is divided into primary diabetes and secondary diabetes. Primary diabetes is further divided into insulin-dependent diabetes, also known as type 1 diabetes; non-insulin-dependent diabetes, also known as type 2 diabetes. Secondary diabetes: pancreatic disease, hormone receptor abnormalities, and decreased glucose tolerance. Insulin-dependent diabetes is more common in children, accounting for about 90% of all types of childhood diabetes. Once diagnosed, standardized insulin treatment should be started as soon as possible. Non-insulin-dependent diabetes is first treated with lifestyle intervention.

2.Are all insulins the same? What are the differences? Can all be used by children?

Since the discovery of insulin, we have developed three generations of insulin. The first generation of insulin is animal insulin. It is the earliest insulin injection preparation used in the treatment of diabetes. It is generally porcine insulin. Porcine insulin differs from human insulin in 1 to 4 amino acids, so it is easy to have an immune response, atrophy or hyperplasia of subcutaneous fat at the injection site, insulin allergic reaction, and due to its high immunogenicity, it is easy to have repeated hyperglycemia and hypoglycemia, and insulin resistance. The second generation of insulin is human insulin. In the 1980s, people expressed high-purity synthetic human insulin through genetic engineering (recombinant DNA) transgenic yeast or recombinant Chinese hamster ovary cells. Its structure is the same as the insulin secreted by the human body. However, it cannot simulate the physiological human insulin secretion pattern in terms of onset time, peak time, and duration of action. It needs to be injected 30 minutes before meals and has a higher risk of nocturnal hypoglycemia. The third generation of insulin is insulin analogs. Using genetic engineering technology, certain parts of the insulin peptide chain are changed to develop insulin analogs that are more suitable for the physiological needs of the human body. It can be used immediately before meals and is also called mealtime insulin or rapid-acting insulin.

According to the "Expert Consensus on Standardized Diagnosis and Treatment of Type 1 Diabetes in Chinese Children (2020 Edition)", it is not recommended for children to use animal-derived insulin and premixed insulin. The genetically recombinant insulin available in my country is shown in the table below.

China has approved the marketing of genetically modified insulin

The goal of insulin replacement therapy is to simulate the normal physiological insulin secretion pattern. The insulin dose is allocated based on the individual needs of the child's condition and an individualized treatment plan is selected.

3. What details should children pay attention to when using insulin?

Unopened insulin should be stored in a refrigerator at 2-8°C. Opened insulin should be stored at room temperature below 25°C, in a dry and ventilated place, away from direct sunlight. When traveling, you can put insulin in an insulated bag. After opening, it can only be used for 4 weeks. Children use a small amount, so if it is not used up, it can only be discarded.

Unopened insulin should be avoided as it is at a lower temperature when just taken out of the refrigerator and can easily cause pain when injected immediately. Therefore, it should be pre-warmed indoors for a while before injection.

The disinfectant used for insulin injection is 75% alcohol. Be sure to record the opening time when using it. The usage period is 7 days. After opening the alcohol, since it is volatile, remember to cover the bottle cap to prevent it from evaporating and reducing the disinfection effect.

Before injecting insulin, you must first check the injection site. When injecting, please avoid injection sites such as subcutaneous fat hyperplasia, fat atrophy, and ecchymosis. Four sites are often selected for insulin injection, including the abdomen, outer thigh, outer upper arm, and outer upper arm. Among them, the abdomen has the fastest absorption rate, with an absorption rate of 100%; the outer upper arm has the second fastest absorption rate, with an absorption rate of 85%; the outer thigh has the third fastest absorption rate, with an absorption rate of 70%; and the outer upper buttocks has the slowest absorption rate. Insulin injection is a long-term process. It is necessary to rotate the injection site and formulate a rotation plan. The injection site can be divided into four equal areas, one equal area is used per week, and it is always rotated in a clockwise direction. For example, a large rotation plan can be formulated: from abdomen---thigh---upper arm---buttocks-abdomen. At the same time, a small rotation plan can also be formulated: the abdomen can be divided into 4 equal areas, and the thighs or buttocks can be divided into 2 equal areas.

References

Expert consensus on standardized diagnosis and treatment of type 1 diabetes in Chinese children (2020 edition)

"Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)"

Chinese expert consensus on the diagnosis and treatment of type 2 diabetes in children and adolescents

Guidelines for Insulin Treatment of Type 1 Diabetes in China

(Harbin Children's Hospital author: Sui Nianhan; reviewer: Jin Yan)