From Virginia, USA:
Our daughter, age 8, diagnosed one year ago with IDDM, is now on 3 shots per day as follows:
She eats proper snacks at 10:30 A.M., lunch at 12:30 and another snack at 3-4:00 P.M. Morning and lunch levels are good.
7:30 A.M. 10.5 NPH (0.5 Lispro if over 120) 6:00-6:30 P.M. 0.5 Lispro 8:30-9:00 P.M. 3.5-4.0 NPH
Our problem is that she is almost always high at dinner (5:45-6:15 P.M.). If we raise the morning NPH to 11 units, she has lows at school in the morning, even after snacktime.
What is the normal duration of NPH for young children? I thought it was 10-12 hours. Should we be altering our dinnertime/Humalog dose, or, perhaps give R at 4:00 P.M. instead of Humalog at dinner?
There is a wide variability in the onset of action of insulin and duration of action. The larger the dose of NPH, the longer it lasts. Also, in my experience, as you increase the dose of NPH, more of it is working earlier, before lunch.
I would suggest discussing with your child's physician possibly changing the regimen a little. You might find that paradoxically decreasing the morning NPH and adding some Regular may actually improve the blood sugar before supper if the regular carries over into the afternoon. Your daughter may not be able to tolerate any Regular on her present dose of NPH, but may not have any lows before lunch if the morning NPH is decreased. If this does not work, you may want to consider adding a little Regular or lispro insulin [Humalog®] before lunch.
Original posting 27 Apr 97
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