A child is on NPH insulin given twice daily, presently six and three units. Post lunch, pre-dinner and post-dinner blood sugar readings are high, in the 250 to 500 mg/dl [13.9 to 27.7 mmol/L] range. The urine sugar readings are always 4+. The doctor still wants to stick to the same insulin. We feel the insulin type should be changed. Can you suggest more appropriate insulin types and doses, if any?

The current insulin regimen seems inappropriate for your child. In fact, injecting only NPH insulin is not sufficient to cover the increase in the blood sugar levels after meals. In my opinion, you could discuss with your child’s team the opportunity to switch to the new long lasting analog insulin, glargine, that covers about 20-24 hours a day with a flat profile (as a baseline insulin), plus rapid acting insulin, such as Humalog or NovoLog, before meals (breakfast, lunch and dinner).

As a second option, you can discuss with the team the opportunity to inject rapid insulin before meals (breakfast and lunch) and a premixed insulin at dinner (long acting plus rapid acting insulin in the same syringe or using a prepared pen) or only rapid acting insulin also at dinner and the long lasting one (NPH) at bedtime.

AS