From Birmingham, Alabama, USA:
My daughter has Type 1 diabetes, diagnosed 6 months ago at age 2 years. She is currently on two shots a day of regular and NPH. She seems to be going very high between 9:00 a.m. and 10:00 a.m., before the Regular insulin is working and then bottoms out in the early afternoon when both the Regular and the NPH are working. She then is high at 6 p.m. and remains high until after 10 p.m. when the p.m. Regular dose starts working and again bottoms out around midnight to 2 a.m. when the NPH starts working along with the remaining Regular. I have been told that this is what we should expect since she is only 2 years old but I think there must be a better way.
Has there been any clinical experience with Humalog in this age group? Humalog seems to be the perfect solution according to the time profiles since it should be gone when the NPH starts working around lunch and during the night. It would also lessen the extreme anxiety that my wife and I have when our 2 year old decides not to eat after we have just given her insulin. Please let us know if this has been utilized in these young kids. If it has not been utilized in kids, why?
Yes, lispro insulin [Humalog®] has been used in young children, and I understand some studies have been submitted for publication describing its use in young children. No, it has not yet been approved by the FDA for use under the age of 12, but this does not mean it cannot be used in young children if the physician feels it is appropriate. Unfortunately, it takes much longer and more safety studies to approve a medication for younger children than for older children and adults.
Yes, Humalog helps to decrease the rise in blood sugars after a meal. This does not necessarily mean that it will definitely provide perfect control, but it does provide another option to help better balance food, insulin, and exercise. It still does not completely mimic the way the body makes insulin.
In my opinion, the major obstacle to using Humalog in this age group is that there is no diluent available yet to dilute Humalog so you can accurately give small amounts and make very small changes in dosage. Many children are extremely sensitive to Humalog, and you may need to take less than a unit at a time, or make changes in 1/4 or 1/10 units at a time. You cannot do this accurately without a diluent. I understand Eli Lilly is actively working on developing a suitable diluent.
In the mean time, you may want to try other insulin regimens to see if they work better. I find it extremely difficult in young children who (hopefully) sleep through the night to balance the food and insulin in the evening to obtain near normal blood sugars at bedtime and before breakfast without going low during the night.
You might want to discuss with your child's physician possibly trying Ultralente twice daily instead of NPH. You could then give Regular before each meal. For children who cannot take a shot before lunch, I have given Regular and small amounts of Lente along with the Ultralente in the morning. The smaller amount of Lente given before breakfast is similar to giving Regular before lunch in "multiple dose" regimens and avoids the 3rd injection at lunch. (You cannot mix NPH and Ultralente in the same syringe -- they are not chemically compatible). You will then need to give Regular again along with the Ultralente before supper. Older children may need a very small dose of Lente again in the evening to prevent the blood sugar from increasing from 3 AM to before breakfast.
Diluents are available for Regular, Lente, and Ultralente. When the diluent becomes available for Humalog, you could try substituting all or part of the Regular with Humalog and giving it after meals. I am looking forward to the availability of diluent for Humalog. I think it will be very useful for many little children like your daughter.
Original posting 13 Jul 97
Last Updated: Tuesday April 06, 2010 15:08:54
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