My son is currently on a two shot regimen. He is using regular and NPH. His A1cs range from 6.8 to 7.2 We met with a specialist who is sold on the four shot routine, using Humalog at meals and Lantus at night. The doctor is set on the four shot routine and only briefly talked about our other options. I would like to set up a three shot routine with Humalog and a long acting insulin. Is the four shot approach so much better as to not consider any thing else? How do I approach this medical professional with my thoughts on the three shot approach?

The purpose of giving insulin is to achieve good control of diabetes with minimal lability of blood sugars. Usually, one cannot achieve such control using the older insulins, such as regular and NPH, and insulin dosing styles such as you are currently using. Making a change to Humalog or NovoLog and Lantus is appropriate. The various styles of taking those two insulins, three shot versus four shot regimens, is up to you and your physician. I hope you feel comfortable discussing your wishes with your physician. If you aren’t comfortable, then it’s time to find someone with whom you’ll be comfortable discussing all aspects of your child’s diabetes care.

Your physician should be very happy that you’ve put so much thought into this and should welcome your comments and suggestions.

MSB