My six year old son has had type 1 diabetes for about two and a half tears and takes 9 units of NPH at breakfast, 10 units of NPH at bedtime and a sliding scale of Humalog at breakfast and supper. Lately, he has very high numbers (200 to 400+ mg/dl [11.1 to 22.2 mmol/L]). What do we do? Should we add another type of insulin to the mix or increase the Humalog?

Very high numbers despite what seems a reasonable dosing of insulin that happens within a couple of years of diagnosis is usually the end of the honeymoon period. It sounds like your son’s insulin dose needs to be increased. He may also benefit from using a different type of insulin that provides for better coverage during the day and night than NPH at breakfast and bedtime. There is a new type of insulin available, called Lantus (insulin glargine) that may be a great tool for your son to try. Talk with your son’s diabetes team about different insulins and different dosing strategies to keep his blood sugars at target levels.

MSB