My eight year old, diagnosed with type 1 diabetes 15 months ago, has had erratic control on twice daily injections of NPH and Regular (other than a few “good months” — not together). His blood sugars routinely fluctuate wildly from 30s to 400s [mg/dl, 1.6 to 22.2 mmol/L] within a couple of days for no obvious reason, and we are continually making dosage adjustments, sometimes eliminating the Regular altogether due to hypoglycemia at lunch and bedtime.

Lantus sounds good, but a noon injection is not an option now at his school. Could Lantus be used at bedtime with only two other injections, morning and evening, of either NPH or Regular insulin? Sure seems like his control should be better.

It is not likely that Lantus (insulin glargine) would work as a basal insulin without lunchtime bolus coverage, but there is no reason that you could not try.

Schools must follow US federal guidelines and provide appropriate medical care and supervision for insulin injections, blood glucose testing, etc. Federal law trumps state and local laws/ordinances.

It sounds like you may want to try other multidose insulin regimens as well. We do not have good results with a twice-a-day regimen and so do not even use this any longer. You should go back to your diabetes team and problem solve with them to find a better program, better algorithms, carbohydrate counting, a better insulin regimen etc.

SB

[Editor’s comment: See The Law, Schools, and Your Child with Diabetes.

SS]