My 21 month old son was diagnosed at 14.5 months of age, and his team of nurses have recommended that we consider putting him on Lantus because he is very sensitive to the peaks of NPH, particularly in the evenings. I know that it is not yet approved for children under six. I would like some objective opinions on what any of you think about putting a 21 month old on Lantus and what I might expect if we decide to make the change.

There are several toddlers on Lantus (insulin glargine) in this center. Given as a single injection at bedtime it does greatly reduce the problem of early morning hypoglycemia from suppertime NPH. Some other modifications are called for, though.

First of all, the bedtime snack is less important and can often be omitted in the interest of having the before breakfast blood glucose be an accurate reflection of the basal glargine action. As a first step, the insulin in the morning is usually switched to Humalog plus NPH to cover the middle of the day. This avoids having to give two extra injections (one for the glargine and another for the insulin cover at lunchtime). Eventually however you may elect to give Humalog again at midday and omit the morning NPH. Suppertime insulin is again Humalog. There seem to be no disadvantages of this approach except perhaps for the need for more blood sugar monitoring, so you might at the same time consider using one of the forearm sample meters like the FreeStyle or One Touch� Ultra.

DOB