Basal insulin degludec seems to be the answer to the issue of a stable basal insulin that lasts for 24 hours or more with a single dose. But because it’s fairly new, it’s still not permitted for use with anyone under the age of 18. But could dilution be the answer?
The manufacturer of basal insulin degludec states that it provides a steady supply of basal insulin for over 40 hours. It’s been found to lower the risk of hypoglycemia significantly compared with other current basal insulin alternatives. But currently, the diabetes mellitus medication isn’t approved for use with children. This is unfortunate because children with diabetes mellitus are more susceptible to hypoglycemia when on basal insulin therapy. Novel dilution preparations of basal insulin degludec are ideally the solution for pediatric diabetes mellitus patients.
Why Children With Diabetes Mellitus Are More at Risk for Hypoglycemia When on Basal Insulin Therapy
Basal insulin shots’ effectiveness can depend on when you take them. Some diabetes mellitus patients report that administering their basal insulin before sleeping causes hypoglycemia during the night – doctors and patients also report that other activities immediately before or after a basal insulin shot affect its activity. The problem is that children have very dynamic schedules and habits – they eat and sleep at variable times everyday and have random spikes in physical activity. They also fast for long periods at random times. All of these factors brew up a nightmare for basal insulin stability – and children below 6 years old have 250 percent higher risk of developing hypoglycemia than older children when on basal insulin therapy.
But children with diabetes mellitus are also under-treated with only about 20 percent of pediatric patients staying within the recommended normal range of blood sugar levels. Researchers say a major cause is the insufficient basal insulin medications available for children. It’s currently a challenge to formulate smaller doses of basal insulin shots of current FDA-approved brands with the accuracy and stability needed to keep steady coverage while avoiding the risk of hypoglycemia.
Diluting Basal Insulin Degludec Could Be an Ideal Solution for Children With Diabetes Mellitus
Pediatric endocrinologist Dr. Elvira Isganaitis of the Joslin Diabetes Center says that diluted basal insulin preparations are kind of rare, but are in need by children and diabetes mellitus patients with increased insulin sensitivity. She says that Novo Nordisk, manufacturer of basal insulin degludec, has only released a U-200 version of the basal insulin shot, which is a more concentrated form rather than a diluted preparation.
The good news is that doctors and other healthcare professionals specializing in pediatric diabetes mellitus know how to dilute currently available basal insulin medications to achieve suitable doses for children, like the commonly used U-10 preparation for preschoolers.
The problem is that the necessary diluent solution for basal insulin degludec hasen’t been formulated. Pharmacists don’t even know what it is – which makes it very difficult for doctors to obtain. And when doctors do prepare a diluted basal insulin solution, it only lasts a few weeks. Parent can be trained to dilute basal insulin, but that’s assuming there’s diluent solution they can get at a pharmacy or hospital.
If Novo Nordisk formulates a ready-to-use U-10 or similar diluted concentration of basal insulin degludec, it would mean less hardship for both pediatric doctors and parents. The diluted basal insulin degludec would be superior in helping prevent hypoglycemia in children with diabetes mellitus, while also providing longer coverage – which means fewer unpleasant injections. If the company can boost the diluted preparation’s shelf life, it would make it cheaper, which means it would be more accessible.
Basal insulin degludec could play a significant role in curbing the under-treatment of diabetes mellitus in children. The key is creating a diluted preparation that can be mass produced for general accessibility.