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June 21, 2006

Insulin Analogs

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Question from Baton Rouge, Louisiana, USA:

We were switched to Levemir two days ago because of the recent discontinuation of Lente. My son has had REALLY good glucose management with Lente. We are not experienced with a non-peaking basal insulin and I want a little information on handling his Humalog in conjunction with the Levemir. Yesterday, his first day, he was relatively high all day. Do we continue with the “base” doses at breakfast and supper as we are used to? Or, do we switch to a strictly carbohydrate to insulin ratio program now? Any information is appreciated. Our doctor and his team did not explain this very well to us.

Answer:

From: DTeam Staff

Insulin therapy with Lantus or Levemir is very different from the therapy with Lente insulin. It is more like pump therapy with Levemir acting as the basal profile with boluses of ultrarapid or rapid-acting insulin before meals.

In my opinion, Levemir should be injected two times a day. As it is likely that he just started this kind of regimen, your son needs a little more time to find the right dose for him. Probably you could obtain better results switching to NovoRapid (NovoLog in the U.S.) as ultrarapid acting insulin instead of Humalog, because its profile is little longer; moreover, it could be necessary to increase the dose of bolus insulin. Another option could be to switch to a Regular insulin that could cover a longer period of time, or to the new premixed insulin like Novomix 30.

I suggest you to discuss all this with your son’s diabetes team. Using a strictly carbohydrate to insulin ratio program could help, but it is mandatory that your son accept this kind of managing his diabetes and not force him to use it.

AS