My 12 year old daughter, who has had type 1 diabetes for six months, is using Lantus in the evening and Actrapid three times a day for meals because we cannot cover the long time span between breakfast and lunch, but I see that you recommend Humalog or Novolog. We’re using this fast acting insulin just if we go to restaurants or if we have no time before lunch or dinner. Is it possible to use both Actrapid and Humalog/Novolog for premeal insulin?

I would be better able to evaluate the effectiveness of your daughter’s insulin regimen if I knew her hemoglobin A1c, but, from the theoretical point of view, her program based on Lantus (insulin glargine) and Actrapid is fine. Glargine (Lantus) is the best choice we have nowadays to better cover the basal requirement between the mealtime boluses which can be an analog (Humalog or Novolog), Regular (Actrapid) or a mixture of the two. Note that any of these should never be mixed with glargine.

With the use of the glargine, fast-acting analogs are generally the best option because their hypoglycemic action is faster and shorter than Regular insulins. Therefore, the timing between a shot of Regular (Actrapid) and eating is not necessary, most of the time and late hypos are sharply reduced. However, if your daughter’s metabolic control as well as her quality of life (analogs make eating and timing much easier, I think) are both fine, there is no reason why you shouldn’t continue with the current scheme.

MS