I have been using a pump for 10 years (hemoglobin A1c 4.8-6.0% for seven years), my four year old son is on multiple injections, and I have been aggressive in trying to match the pump for him. I use Humalog for high carb low-fat meals, Regular for low-carb meals, a mix of Humalog and Regular for high fat, high carb meals, and diluted Humalog for correction doses. I think my doctors are happy with his A1c (4.7-6.0%) and few lows, but I had to tell them about mixing insulins because they never offered the information to me. What experience do you have with trying this? Do you think it could benefit patients to know this information?

Mixing Regular and Humalog in the same syringe is a fairly usual in situations in which personal idiosyncrasy or special situations warrant some extension of the action of the short acting insulin component. Taking account of changes in the fat content of a meal in judging mealtime Humalog is however not a common practice, although it is a perfectly logical one which can, as you have shown, lead to extraordinarily good control.

There are several reasons why doctors don’t offer this option. One is that there are few mothers who have had the long experience in managing their own diabetes that gives them the confidence to make these adjustments appropriately. More importantly perhaps, the present tendency is to use what has sometimes come to be called the ‘poor man’s pump’. That is, the use of Lantus (insulin glargine) for the basal rate insulin need (even in a four year old) with Humalog at mealtimes, but given immediately after the meal with the dose adjusted for appetite, pre-meal blood sugar and the number of ‘carbs’ actually consumed.

DOB