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November 9, 2007

Daily Care, Insulin

Question from Male, Republic of Maldives:

When diagnosed in June, my daughter was first treated with Mixtard insulin. We do not have enough medical facilities in Maldives to undergo certain tests like GAD antibody testing, insulin antibody testing or islet cell antibody testing. We had to travel abroad to undergo these tests. The endocrinologist advised us not to use Mixtard (15 units in the morning and seven units at night) as the readings were fluctuating. So, with his advice we changed to human Insulatard and Actrapid insulin (morning - five units of Actrapid and eight units of Insulatard; and night -three units of Actrapid and four units of Insulatard). Our local doctor is not happy with this change and my daughter's blood sugars are still fluctuating, usually getting a low by mid-day. What type(s) of insulin do you recommend?

Answer:

Glargine (Lantus) insulin is actually the best options as a basal insulin, especially in children. That said, I really don’t know if glargine is currently available in your country, but I think it may be obtained from abroad. Any fast acting insulins (preferably analogues such as lispro (Humalog) and insulin aspart(NovoLog)) can be used before each meal. Please discuss this with your current doctor.

MS

[Editor’s comment: With respect to your daughter’s fluctuating blood sugars, you may benefit by reading some of our previous questions on the diabetes Honeymoon, the period after diagnosis in which there is some restoration of insulin production and the blood sugar levels improve to normal, or near-normal, levels. Unfortunately, like other honeymoons, this diabetes honeymoon doesn’t last forever; it may last for weeks, months, or occasionally, years.

BH]