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Insulin should be given by continuous infusion. The initial dose is 0-1 units/kg/hour. Once the blood sugar falls to less than 10 mmol/l, glucose must be added to the IV. Do not stop using insulin. This is the child's prime requirement. Administer the insulin by separate line. Add 25 units of soluble insulin to 50 ml saline. This solution is 0.5 unit/ml: 0-1 units/kg/hour is equal to 0-05 x weight in kg, as ml/hour. Thus a 20-kg child would have 2 ml/hour, a 35 kg child 3-5 ml/hour. This often needs decreasing when blood sugar starts to fall. In a very young diabetic (under 5 years), start with the smaller dose.

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