My five year old son, who has had type 1 diabetes for two and a half years, goes to all day kindergarten is on a NPH with Humalog in the morning and at dinner, and his A1c has been hovering around 7.0%. I agree that the idea of insulin glargine for basal insulin needs plus Humalog to cover mealtimes would probably be better, but the logistics of it seem impossible since school personnel will not administer insulin. That would mean t I would have to go to his school every day at lunch time, which is not possible. How do other people do this? Do they just wait until their kids are old enough to administer their own insulin?

I think you have several options. Perhaps the one most attractive in my mind is to do nothing different that you are doing now. After all, you indicated that his hemoglobin A1c is about 7% — which is terrific!

I do have a question back: What do the schools do if the glucose is high and the child requires a bit more insulin rather immediately (such as with concurrent urine ketones)? Do they refuse to give insulin then? Is there a school nurse?

You might be able to engage a family friend, another relative, or even a teacher to be your ally. In the United States, one can formulate an IEP or 504 Plan – at least for public schools. I do not know if similar opportunities are available in Canada.

You could give the Lantus (insulin glargine) at bedtime as you indicated, but still give a little NPH at breakfast to “cover” the lunch that’s coming. I do not believe that Lantus is approved by the US FDA for use in children as young as your son; again, and I am unfamiliar with Canadian nuances.

DS