PeDiabetes

Clinical Tool

Fill in the daily dose to autocalculate Factor and Ratio (Rule 1800/500). In Spain: 1 Serving = 10g HC.

mg/dl
mg/dl

Calculated Clinical Parameters

Descent x 1 IU

IU x 10g HC

Recommended Bolus

0.0 UI
Correction 0.0 UI
Meal 0.0 UI
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For use only by healthcare personnel.
Medical judgment prevails.

Vademecum

Spain

Ultrafast

Lispro Humalog®, Lyumjev®

Start: 10-15 min | Peak: 1-2h | End: 3-5h.

Aspart Novorapid®, Fiasp®

Start: 10-20 min | Peak: 1-3h | End: 3-5h.

Glulisine Apidra®

Start: 10-15 min | Peak: 1-1.5h | End: 3-5h.

Application: 0-15 min before. Lyumjev and Fiasp (2nd gen ultrafast) up to 2 min before or 20 min after the start of ingestion.

Slow / Basal

Glargine U100/U300
Lantus®, Abasaglar®, Toujeo®

Start: 1-2h. Without peak. Duration: 20-24h (Toujeo up to 36h).

Detemir Levemir®

Start: 1-2h. Mild peak: 3-9h. Duration: 12-24 hours (usually requires 2 doses in pediatrics).

Degludec Tresiba®

Start: 30-90 min. Flat. Duration: >42h. Allows time flexibility.

Considerations

  • Lipohypertrophies: Check puncture areas. Injecting there drastically alters absorption.
  • Zones: Abdomen (fast, bowling), Thighs/Buttocks (slow, basal).
  • Children's Pens: Cartridges (Echo, JuniorSTAR) allow half units (0.5 IU).

Protocols

Ketoacidosis (DKA)
Criteria: Gluc > ​​200 + pH < 7.30 (or HCO3 < 15) + Cet>3 (or ++).

1. Fluid therapy (Crucial)

  • Expansion: SSF 0.9% 10-20 ml/kg in 1-2h (Max 1L). Slow if there is a risk of cerebral edema.
  • Maint + Deficit: Calculate at 48h (SSF or GS).
  • Add K+ (40 mEq/L) after diuresis, even with normal K.

2. IV insulin

  • NEVER initial bolus. Start 1-2 hours *after* fluids.
  • Dose: Continuous perfusion to 0.05-0.1 IU/kg/h.
  • Maintain until resolution (pH>7.3, HCO3>15, Cet<1).

3. SC Transition

  • Put quick SC and stop IV at 30-60 min (2h if basal) to overlap.
Hyper decompensated

No acidosis but mild ketosis or symptoms.

  • Hydration: Abundant oral route. If not, SSF IV.
  • Dose: Use Sensitivity Factor. If it debuts: 0.1 IU/kg (or 0.05 IU/kg if < 5 years) rapid SC.
  • Reassess in 2 hours.
Severe Hiccups (< 70)
Conscious Patient
  • Give 15g quick HC (1.5 sachets of sugar). Children: 0.3g/kg.
  • Wait 15 min and repeat. Then slow HCs.
Unconscious/Seizure
  • Glucagon IM/SC:
    <25kg: 0.5mg | > 25kg: 1mg.
  • Alternative IV: Glucosate 10% (2-5 ml/kg) slow bolus.