My 11 month old son is still hanging in there. His latest hemoglobin A1c was 9.4%, and he needs to be at 8% or below. He is never really close to the normal range. Is he too young for Humalog? He is now on 3 units of Lente with 1 unit of Regular in the morning and 4 units of Lente with 1 unit of Regular in the evening. We just took him off of noon R to see how he does. The challenge now is introducing foods!

In general the glycemic goal for toddlers is a little higher/looser than for older children and adults. So a 9.4% hemoglobin A1c is not too disturbing in an 11 month old. As he gets older, you are right that his goal will be for tighter control.

I don’t think anyone is “too young” for Humalog, but Humalog is not a panacea. The “right” dose for anyone with type 1 diabetes is one that keeps the glucose target ranges most of the time to prevent DKA [diabetic ketoacidosis], chronic highs, and avoids frequent lows. The advantage of Humalog is that, since it works so quickly, it can be given after meals. This can be very advantageous in a toddler, since you can’t always predict how well he will eat. With the help of your son’s diabetes team, you can learn to dose Humalog based on what your son actually eats. The disadvantage of Humalog is that it does not last long in the system and must be used in conjunction with a long acting insulin. Many endocrinologists combine Humalog with NPH or even Ultralente. When insulin Lantus (insulin glargine) is available, Humalog may be used with that (although separate shots will be required). So with Humalog, you would have to dose it with each meal and heavy snack.

DS

[Editor’s comment: Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge & Richard Rubin is full of strategies for dealing with diabetes and toddlers.

SS]