My six and a half year old daughter has had type 1 diabetes since she was two years old. She has been prescribed by her internist-diabetologist to change her insulin injections to Insulin 30/70 Human Biphasic Isophane (Mixtard 30 Novolet) from January this year. She is to take 12 units in the morning and 10 units in the evening. Prior to that, my daughter used to get injected with Regular and a long acting insulin in a vial, mixed together, three times a day. Although my daughter’s blood sugar levels are mostly good, I wonder if this premixed insulin 30/70 is the best regimen for her.

Most pediatric diabetologist do not recommend premixed insulins, which are used by older patients who cannot monitor glucose levels. Most pediatric diabetologist favor intensified treatment aimed at providing maximum flexibility with food and activity, frequent monitoring to allow food and insulin adjustments and optimize overall control. This bolus-basal regimen can use Regular or analog insulin before meals plus intermediate or longer acting insulins. Pumps do this with basal provided by hourly adjusted slow drips of insulin plus boluses before meals/snacks. This mimics what the normal pancreas is supposed to do. I think it is not the best system unless you are limited by lack of monitoring possibilities, so I do not understand why this would be recommended. A textbook that I wrote has a chapter that describes the various insulin regimens available and the pros/cons of each. The book, Pediatric and Adolescent Diabetes and can be purchased via Amazon.com. Type 1 Diabetes in Children, Adolescents and Young Adults by Ragnar Hanas, M.D. also has an excellent chapter that describes insulin treatment regimens and options to consider. It is also available via Amazon.com as well as this web site.

SB