An assessment of the benefits of pre-mixed insulins in childhood diabetes

Twice daily injections using soluble and isophane insulins which are withdrawn from two separate vials and mixed in the syringe are widely used in children with diabetes mellitus. This is a technically difficult task for children and parents to perform. We have found that errors in the dose given and in contamination of soluble insulin by isophane are common. We have conducted a prospective study to assess the effects of changing children from a soluble and isophane regime, using separate vials, to a ready‐mixed single vial combination. Thirty two children aged between 6.9 and 11.3 years were studied concurrently at intervals for three months. Ninety seven per cent were able to draw up their insulin dose accurately after three months (50% at outset) and 81% were able to give their own injections (62% at outset). The involvement, independence and self‐confidence of the children improved which permitted a less restricted social life. There was no change in glycosylated haemoglobin or fructosamine levels. Mixtures of soluble 20% isophane 80% and soluble 30% isophane 70% were found to be the most suitable. Eighty four per cent were able to use the same mixture for both morning and evening injections.