My eight year old son, diagnosed with type 1 diabetes about 21months ago, was started on NPH and Regular at breakfast and supper. He has had a lot of highs and lows, and, in fact, he is rarely in his goal range. Yesterday, we saw a new pediatric endocrinologist who suggested that we change to Ultralente at breakfast and supper with Humalog at breakfast, lunch, and supper. How do these treatments differ? What changes can we expect to see?

Ultralente is a longer acting insulin than NPH and should provide better insulin coverage for all 24 hours than NPH twice a day. Humalog insulin is a rapid acting insulin and should provide better mealtime coverage than Regular insulin. Overall, using Humalog and Ultralente together should provide a better way of reaching your goals of improved blood sugar control.

I would suggest reviewing blood sugars on a regular basis with your son’s diabetes team to help make any dosing corrections that may be needed in your son’s new insulin doses until you are comfortable making those changes yourself. You may also wish to read more about the various types of insulin.

MSB

[Editor’s comment: Ideally, using the new insulin regimen you describe, your son’s premeal Humalog dose should be based on the carbohydrate content of the meal. Appropriate dosing should yield postprandial blood sugars of less than 50 mg/dl [2.8 mmol/L] above the premeal value.

When starting this regimen, it is important that your son check both premeal, two-hour postmeal, and probably some nighttime (about 2-3 am) blood sugars to make sure doses are correct. If you are not familiar with carbohydrate counting, make an appointment with a dietitian.

SS]