How many times per day can we use Humalog? Is there a maximum? Can we use at the same time with Regular?

There is no magic number of injections of any insulin regimen. This all depends upon the individual and the blood glucose levels, target goals, etc. Many people believe that either an insulin pump or a basal/bolus program gives maximum flexibility and optimum control as it tries to mimic what the normal pancreas is supposed to do. This is a difficult task, and often we still do not deliver insulin in the same way as a pancreas can. Many pediatric diabetologists use this approach and have great success with hemoglobin A1c levels better than those achieved in the DCCT.

We don’t believe that mixing Humalog or NovoLog with Regular insulin makes much sense. We think the main goal of bolus therapy is to better cover the postprandial blood glucose peaks not the basal needs. We use either Lantus or pumps for basal rate insulin needs. The reason that you would likely need longer duration bolus insulin is artificially caused by experience with older insulins.

With the older and longer duration insulins, they didn’t stop working so quickly and so snacks were mandatory. Most of our patients do not snack between meals and, if they do they cover with a bolus of analog insulin. Again, the goal is mimicking the pancreas as much as possible. The tail effect of Regular insulin is likely responsible for some episodes of hypoglycemia. The analogs decrease the hypoglycemia that occurs by cutting down the tail effect. There are some very good diabetologists who disagree with this philosophy and suggest mixing combinations of analog and regular insulins, however. The proof is always in what degree of control is achieved, A1c levels, preventing hypoglycemia, etc.

SB