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February 24, 2003

Insulin

Question from a school nurse in Rushville, Indiana, USA:

I have a student who takes Humalog and Lente. She has been fairly well controlled until recently and is experiencing some lows before lunch with high numbers in the evening and night, spilling a trace or small amount of ketones. They have a goal to be on the insulin pump soon, but her hemoglobin A1c is not at the level they want it to be yet, and a pharmaceutical representative at one of the pharmacies told the mom that no child should be on Lente insulin. Could I please have your input on this issue?

Answer:

The pharmaceutical representative is just wrong. Lente is an excellent intermediate acting insulin. Some people like it better than NPH and some have a preference for NPH. Not much science that says one or the other is better, and good diabetes people use both. Insulin decision should be based upon actual blood glucose results and not arbitrary choices of one.

SB
Additional comments from Dr. Donough O’Brien:

A regimen of Humalog with Lente is a logical successor to the old Regular and NPH, but it is not going to afford as good control as the more demanding and more recent regimen of Lantus (insulin glargine) at bedtime calibrated to the morning fasting blood sugar together with Humalog or NovoLog just after meals so that the dose can be adjusted for pre-meal blood sugar and the ‘carbs’ actually consumed. NPH at breakfast is sometimes added here so as to avoid an injection at lunch time. If control is now reasonable and the intention is to move to a pump soon then it is not necessary to try this approach first. If good support is available, there is no reason to delay starting on a pump.

DOB
Additional comments from Dr. David Schwartz:

I presume that the drug rep is from a company that does not market Lente.

DS