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May 28, 2009

Daily Care, Insulin Analogs

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Question from Irving, Texas, USA:

My 11-year-old daughter has been taking 17 units of Lantus at bedtime and is on a sliding scale of NovoLog at meals. She ran out of Lantus before her supplies have come in and has been without it for almost a week. I called her doctor to see if we could get a sample. The pharmacy was out so I was told to check her blood sugars every two hours and to give her NovoLog injections every two hours to help keep her blood sugars down. Is there anything else I can do or should do until we get her back on Lantus?

Answer:

From: DTeam Staff

I’m always a little wary when someone writes that they use a “sliding scale” of rapid-acting insulin, such as NovoLog. I think what you mean is that you have a “formula” or so of sorts that helps you calculate how much insulin to give for meals AND to “correct” for the concurrent glucose that is higher than your target glucose. Assuming this is correct, then the directions your doctor gave you should be adequate until such time that you can obtain your long-acting Lantus insulin.

This should work fine for the 12 to 24 hours until you find an open pharmacy. In fact, by the time you receive this reply, the “crisis” should be over. If this were over a weekend, you might be able, through your doctor’s office, to find the local Lantus pharmaceutical representative to see if s/he has any samples. Apparently your doctor didn’t have samples. (On a rare occasion, I would go to my office late at night or weekends to provide insulin samples to patients who ran into such an emergency.)

The lesson here is to be aware of your insulin reserves and not be without! Also, find a 24 hour pharmacy and recognize that you can pay OUT-OF-POCKET for Lantus insulin, as long as you have a prescription. In fact, for Regular and NPH insulin, you don’t even need a prescription, as long as you are willing to pay out-of-pocket. You would need to discuss dosing of such insulins with your diabetes team.

DS