My three year old daughter was diagnosed three months ago, and her diabetes team recently switched her to Lantus with Humalog at every meal (and sometimes snacks). So we are talking about four to five shots a day for a three year old. With this regimen should she go on a pump or an infusion set?

This basal/bolus or Multiple Daily Injection regimen using once-daily Lantus (insulin glargine) with Humalog is also getting more popular, but I think that common sense is needed too. Frankly, I am not worried about her getting four to five shots daily. I am more worried about your attitude towards all the shots. If it is getting difficult for you, your child will likely sense that and also be upset.

For a newly diagnosed toddler, often simple “split doses” of NPH and Regular may be all that is needed and still be getting reasonable control. While we know that good control is better than poor control, there are not a bunch of data showing that in the toddler this is pertinent. As you know, Lantus must be a stand-alone shot, but you can do similar basal/bolus therapy using Ultralente rather than Lantus. Ultralente often must be given every 12 hours, but it can be mixed with other short-acting insulins. Therefore you can give the breakfast shot of Ultralente and short-acting, a short-acting at lunch, and Ultralente plus short-acting at dinner. That takes you to three shots. If she is on Humalog or Novolog, then she may need that with snacks also. If she does routinely snack and you don’t want to dose her for that snack, you might be able to use Regular with the meals. Regular covers the meal plus a snack given within about four hours. Of course, with Regular, she may be obligated to have the snack, so Humalog allows more flexibility.

Please relay your on-going concerns and questions to your diabetes team. However, the basal/bolus regimen is often the precursor to insulin pump therapy. You can discuss these options with your daughter’s diabetes team.

DS