Stand Alone Basal Insulin:
Whenever Intermediate acting steroids are used as a single morning dose, resultant hyperglycaemia is known to increase as the day progresses, peaking post lunch, slowly settling by night. Hence, a single morning dose of Neutral Protamine Hagedorn (NPH), which has similar pharmacokinetic (peak action 4-8 hours, duration of action 12-16 hours) profile as that of intermediate acting steroids will best suit this scenario(42)(25). Clore et al(42) used a weight and steroid dose dependent algorithm in adults, using NPH insulin based on known dose-response effects of glucocorticoid on insulin sensitivity and their empiric observation over 5years. They found 0.4 U/kg, 0.3 U/kg, 0.2 U/kg, 0.1 U/kg of NPH for prednisolone ≥ 40 mg/day, 30 mg/day, 20 mg/day, 10 mg/day respectively resulted in excellent glycaemic control. Hence, in the absence of vast experience it is suggested to begin with similar dose of NPH in children in this scenario.
Single dose, patient comfort, easy titration are advantages of this regimen. However, in case of persistent hyperglycaemia, an increase in the dose of morning NPH and/or additional prandial regular/rapid acting insulin would be required.