Insulin in the Early Weeks

Insulin is the correct first treatment for nearly every baby with neonatal diabetes, whatever the genetic cause turns out to be. It is started straight away, while testing is under way.

In hospital it usually begins as a drip into a vein, because that can be adjusted continuously while your baby is stabilised. Within roughly two weeks most babies move to insulin given under the skin.

The defining practical problem at this age is how small the doses are. A newborn may need a fraction of one unit — an amount that ordinary syringes and pens cannot measure reliably.

There are two usual solutions:

• Diluting the insulin so a measurable volume contains the tiny dose needed. Manufacturers make specific diluents for this; where those are not available, Indian units have described diluting with sterile saline.
• An insulin pump, which can deliver very small amounts continuously and precisely. It is the more accurate option, and the more expensive one.

Encouragingly, babies with neonatal diabetes often need less insulin per kilogram than children with Type 1 diabetes do.

This stage is often temporary. If your baby has a potassium channel cause, a tablet may replace injections.