Type 1 Diabetes in Children: What to Do When Initial Insulin Therapy Fails to Meet Glycaemic Targets
In children and adolescents with type 1 diabetes, management begins with an individualised basal-bolus insulin regimen. When that starting regimen does not bring glucose and A1C into range, the protocol defines a specific next step — intensified management.
Previous Treatment — Escalation Trigger
The preceding line used rapid-acting insulin analogues combined with basal insulin, given subcutaneously on an individualised schedule. Escalation to this protocol is triggered when the following targets are not met:
- A1C target ≤7.5%
- Fasting/preprandial plasma glucose 4.0–8.0 mmol/L
- 2-hour postprandial plasma glucose 5.0–10.0 mmol/L
Intensified Management — Next Step
This protocol calls for an intensified diabetes management approach — encompassing increased education, closer monitoring, and more frequent contact with the diabetes team — alongside a defined modification to insulin delivery. The complete protocol specifies the precise nature and sequence of that change.
Glycaemic Targets at This Line
- A1C target ≤7.5%
- Fasting/preprandial plasma glucose 4.0–8.0 mmol/L
- 2-hour postprandial plasma glucose 5.0–10.0 mmol/L
References
DOI: 10.1016/j.jcjd.2017.10.036
- If these goals are not being met, an intensified diabetes management approach (including increased education, monitoring and contact with diabetes team) should be used
- Increased frequency of injections
- Change in the type of basal and/or bolus insulin
- Change to CSII therapy
- Children and adolescents <18 years of age should aim for an A1C target ≤7.5%