I know that Ultralente is not the most popular basal insulin for children, but when it is, how do you estimate the initial dose? Do you have the children skip certain meals and test to see if the Ultralente is holding the blood glucose steady or rising or falling? How do you determine if the Ultralente is at the right dose, and at the correct time of day and/or night? Can you be as detailed as possible in describing how you factor out the effects of the basal versus the other doses and correct the doses as needed?

You should discuss this directly with your diabetes team since no formula can answer such an individual question. Detailed blood glucose testing is the general fashion in which such detective work is accomplished keeping as many other variables constant as possible.

SB

[Editor’s comment: From your question, I can’t tell whether you are a health care professional or a parent. If you are a parent, you need to discuss this with your child’s diabetes team. As Dr Brink has already stated, you will need to monitor frequently to adjust the doses. Pre-meal and middle of the night blood sugars tell you about the Ultralente and two-hour postprandial blood sugars tell you about the short-acting insulin.

Stop the Rollercoaster by John Walsh, Ruth Roberts, Lois Jovanovic-Peterson, is an in-depth look at the use of flexible insulin therapy (multiple injections per day). It details how to determine the correct background insulin level and how to determine the pre-meal short-acting insulin required to cover the carbohydrates in the meal.

SS]