Question from Nicosia, Cyprus:

We use carbohydrate counting for meals and give our son Humalog and Lantus. Many times, after injecting his dinner Humalog, our son’s blood sugar drops to 45 to 70 mg/dl [2.5 to 3.9 mmol/L] within 40 to 60 minutes, whether his blood sugar is 150 or 300 mg/d, [8.3 or 16.7 mmol/L]. It’s worse when he eats a fattier meal, e.g., homemade burgers or fish nuggets, etc. along with his rice. He used to be on Actrapid, but found that worse and less predictable and weak in general. Should we try going back to that to avoid the quick Humalog peak? On the other hand, it’s great that when he is high, Humalog just brings him down. However, as noted, this is always temporary. This is evident after lunch, when we may get a drop down to 70 mg/dl [3.9 mmol/L] within the hour, but then 200 to 300 mg/dl [11.1 to 16.7 mmol/L] two hours later, without a snack. Is there a connection with the Lantus here? Should we increase the dose? What do you think?