This handout is for type 1 diabetes (chronic outpatient — pediatric + adult). Your care team identified this based on: hba1c ≥6.5% / random glucose ≥200 with symptoms / 2-h ogtt ≥200 / fasting ≥126 (ada 2026 §2).
Other reasons your team may use this plan: polyuria + polydipsia + weight loss + fatigue ± nocturnal enuresis (ada 2026 §2; ispad 2022); positive gad65 / ia-2 / znt8 / insulin autoantibody (ada 2026 §2; ispad 2022); low c-peptide with hyperglycemia — t1 phenotype (ada 2026 §2).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| insulin glargine | TDD 0.4-0.8 U/kg/day (peds 0.5-1.0 U/kg/day in honeymoon; up to 1.5 U/kg/day in puberty); 50% as basal once daily | SC | once daily (or BID for U-100 if duration <24 h) | Long-acting analog basal; onset 1–2 h, no pronounced peak, duration 20–24 h. Intensive glycaemic control ↓ retinopathy 76% (95% CI 62–85), nephropathy 39–54%, neuropathy 60% (DCCT, PMID 8366922); long-term any-CVD ↓30% (7–48) at 30 y (DCCT/EDIC, PMID 26861924). ADA 2026 §7; ISPAD 2022 |
| insulin degludec | 50% of TDD as basal once daily | SC | once daily | Onset 1 h, flat PK, duration >42 h. SWITCH-1: overall symptomatic hypo RR 0.89 (0.85–0.94), nocturnal RR 0.64 (0.56–0.73), severe hypo 10.3% vs 17.1% (RD −6.8%, −10.8 to −2.7) vs glargine U-100 (PMID 28672316); DEVOTE severe-hypo RR 0.60 (PMID 28605603); ADA 2026 §7 |
| insulin lispro | 50% of TDD divided across meals; ICR ≈ 500/TDD; CF ≈ 1800/TDD | SC | before meals (or 5-15 min before for ultra-rapid) | Prandial component; onset 15 min, peak 1–2 h, duration 3–5 h (CF 1800/TDD with rapid analog, 1500/TDD with regular insulin) (ADA 2026 §7; ISPAD 2022) |
| insulin aspart | Same as lispro | SC | before meals | Equivalent prandial (ADA 2026 §7) |
| insulin glulisine | Same as lispro | SC | before meals | Equivalent prandial (ADA 2026 §7) |
| faster aspart (insulin aspart fast) | Same as standard rapid | SC | 0-2 min before or 20 min after meal start | Faster onset for tighter post-prandial control; pediatric flexibility (ADA 2026 §7; ISPAD 2022) |
Plan: T1DM basal-bolus insulin regimen (MDI) — peds + adult
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Continued education, technology upgrades, mental health, reproductive counselling, transition — adolescent to adult care (ADA 2026 §14; ISPAD 2022), vaccinations (ADA 2026 §4)
Guideline: ADA Standards of Care in Diabetes 2026 (Diabetes Care 49 Suppl 1; AID-preferred Rec 7.25a, no-prereq Rec 7.8a, CGM-at-onset Rec 7.15) + ISPAD 2022/2024 + ATTD/Battelino time-in-range consensus + DCCT/EDIC long-term outcomes