My three and a half year old son was been diagnosed with type 1 diabetes in June 2006. Since then, he has been on Lantus and Apidra, currently on one or two units of Apidra before meals (three times a day) and five units of Lantus at night. One week after diagnosis, his A1c was 9.7. At the begriming of August, it was down to 8.1. I read that Lantus hasn’t been tested on children under the age of six. Apidra, in use here in South Africa for the past five months, also has not been tested on children under six. Is this combination of insulins recommendable for such a young child, or are the “tried and tested” (over long periods of time) insulins the first option for a doctor treating children under six?

While there are no formal trials of these insulins, there is no reason to believe that they should not be used in any patient with diabetes. Lantus is used in many parts of the world, including the U.S., in our own practice extensively for many years quite successfully and has essentially replaced NPH as our basal insulin when we are not prescribing insulin pumps. Apidra is too new, but there is no scientific reason of which I am aware not to use it interchangeably with NovoLog or Humalog. All three of these insulins look rather similar in studies to date. Cost and delivery convenience factors, as well as availability, should be paramount concerns. Lantus often does not last 24 hours in youngsters, so they need a morning plus evening regimen for better basal insulin effect. Occasionally, children, especially the youngest, even need a reverse proportion with greater morning rather than evening dose. All such decisions should be based upon actual blood glucose profile data rather than any dogma. The goal remains the best glucose control with the least hypoglycemia.

SB