Role of Ultra-Rapid Acting Insulins in Management of Preschool Children with Type 1 Diabetes

Excerpt

Management of T1DM in young, preschool-aged children, is challenging. They have heightened insulin sensitivity which requires more precise insulin dosing. They also have unpredictable physical activity, food intake, and behavior. Thus, calculating the bolus dose of pre-meal insulin, which takes into consideration expected amount of carbohydrates in the meal to be consumed and physical activity during subsequent hours, is difficult. This makes the young child with T1DM particularly vulnerable to glycemic variability. Additionally, their limited ability to recognize and communicate symptoms of hypoglycemia increases the risk of undetected episodes [1]. Administering insulin closer to/after mealtime offers a distinct advantage in this situation, as it aligns the dose with the timing and content of the meal. This allows greater flexibility, while reducing the likelihood of hypo- or hyperglycemia. This approach has been used with rapid-acting insulins like insulin aspart and lispro, with success [2, 3]. Recently, two new “ultra-rapid acting” insulin analogs - Faster Acting Aspart (FiASP) and Insulin Lispro-aabc have been introduced. These formulations have an even faster onset of action, reducing the interval between insulin injection and its effect. This quick action provides additional dosing flexibility, as they can be administered at the start of, or within 20 min of starting the meal. Studies in children and adolescents have shown that ultra-rapid acting insulins offer improved postprandial glycemic control with comparable or better HbA1c and similar safety profiles compared to rapid-acting insulins [4, 5]. …