Which medications in the drug class Antidiabetics, Insulins are used in the treatment of Pediatric Type 1 Diabetes Mellitus?

Updated: Jul 03, 2019
  • Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Antidiabetics, Insulins

These agents are used for the treatment of type 1 diabetes mellitus, as well as for type 2 diabetes mellitus that is unresponsive to treatment with diet and/or oral hypoglycemics.

Insulin aspart (NovoLog)

Rapid-acting insulin. Insulin aspart is approved by the FDA for use in children aged >2 y with type 1 DM for SC daily injections and for SC continuous infusion by external insulin pump; however, it has not been studied in pediatric patients with type 2 DM. Onset of action is 10-30 minutes, peak activity is 1-2 h, and duration of action is 3-6 h. Insulin aspart is homologous with regular human insulin, with the exception of the single substitution of the amino acid proline with aspartic acid in position B28. The drug is produced by recombinant DNA technology. Insulin lowers blood glucose levels by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. It inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis. Insulin is the principal hormone required for proper glucose use in normal metabolic processes.

Insulin glulisine (Apidra)

Rapid-acting insulin. The safety and effectiveness of SC injections of insulin glulisine have been established in pediatric patients (aged 4-17 y) with type 1 DM; however, it has not been studied in pediatric patients with type 2 DM. Onset of action is 20-30 minutes, peak activity is 1 h, and duration of action is 5 h. Insulin glulisine is a human insulin analog produced by recombinant DNA technology using a nonpathogenic laboratory strain of Escherichia coli (K12). It differs from human insulin by replacement of asparagine at the B3 position with lysine, and the replacement of lysine at the B29 position with glutamic acid. Insulin regulates glucose metabolism by stimulating peripheral glucose uptake by skeletal muscle and fat, and inhibits hepatic glucose production.

Glucose lowering with insulin glulisine is equipotent to that of regular human insulin when it is administered intravenously. After subcutaneous administration, insulin glulisine has a more rapid onset and a shorter duration of action than does regular human insulin. It is useful for the regulation of mealtime blood glucose elevation.

Insulin lispro (Humalog)

Rapid-acting insulin. Only lispro U-100 is approved by the FDA to improve glycemic control in children aged >3 y with type 1 DM; however, it has not been studied in children with type 2 DM. Onset of action is 10-30 minutes, peak activity is 1-2 h, and duration of action is 2-4 h.

Regular insulin (Humulin R, Novolin R, Myxredlin)

Short-acting insulin. Novolin R has been approved by the FDA to improve glycemic control in pediatric patients aged 2-18 y with type 1 DM; however, it has not been studied in pediatric patients with type 2 DM. Humulin R is indicated to improve glycemic control in pediatric patients with diabetes mellitus requiring more than 200 units of insulin per day; however, there are no well-controlled studies of use of concentrated Humulin R U-500 in children. Onset of action is 0.25-1 h, peak activity is 1.5-4 h, and duration of action is 5-9 h.

Insulin NPH (Humulin N, Novolin N)

Intermediate-acting insulin. It is indicated to improve glycemic control in pediatric patients with type 1 diabetes mellitus. Onset of action is 3-4 h, peak effect is in 8-14 h, and usual duration of action is 16-24 h.

Insulin glargine (Lantus)

Long-acting insulin. The safety and effectiveness of glargine U-100 have been established in pediatric patients (6-15 y) with type 1 DM; however, it has not been studied in pediatric patients with type 2 DM. In addition, the safety and effectiveness of glargine U-300 have not been established in pediatric patients. Onset of action is 3-4 h, no pronounced peaks, and duration of action ranges from 10.8 h to more than 24 h.

Insulin detemir (Levemir)

Long-acting insulin. Insulin detemir is indicated for once- or twice-daily SC administration for the treatment of pediatric patients (aged 6-17 years) with type 1 DM; however, detemir has not been studied in pediatric patients with type 2 DM. Onset of action is 3-4 h, peak activity is 6-8 h, and duration of action ranges from 5.7 h (low dose) to 23.2 h (high dose). Prolonged action is a result of the slow systemic absorption of detemir molecules from the injection site. This agent is indicated not only for daily or twice-daily SC administration for adults and pediatric patients with type 1 DM, it is also indicated for adults with type 2 DM who require long-acting basal insulin for hyperglycemic control.

Insulin detemir's primary activity is regulation of glucose metabolism. It binds to insulin receptors and lowers blood glucose by facilitating cellular uptake of glucose into skeletal muscle and fat. The drug also inhibits glucose output from the liver. It inhibits lipolysis in adipocytes, inhibits proteolysis, and enhances protein synthesis.

Insulin degludec (Tresiba)

Ultra–long-acting insulin. Insulin degludec is approved by the FDA to improve glycemic control in pediatric patients aged >1 y with type 1 or type 2 DM. It usually takes 3-4 days for insulin degludec to reach steady state, peak plasma time is 9 h and the durations of action is at least 42 h. It is highly protein bound, and following SC, the protein-binding provides a depot effect.

Insulin degludec is produced by a process that includes expression of recombinant DNA in Saccharomyces cerevisiae followed by chemical modification. Insulin degludec differs from human insulin in that the amino acid threonine in position B30 has been omitted and a side-chain consisting of glutamic acid and a C16 fatty acid has been attached.


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