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November 22, 2016

Daily Care, Insulin

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Question from Muscat, Oman:

My eight-year-old relative has had type 1 for about six years. Her mother gives her a Lantus insulin injection, once daily, in the morning and thats it! She is not using any Actrapid for meals. However, her blood sugar is very well controlled, and her three month average is almost perfect. The mother gives her a very high dose of Lantus and then she will eat small meals/snacks every 2 hours or so, so that no sharp peaks occur. Rarely, she will require Actrapid for eating desserts. The specialists say that they never encountered such a case, but as long as the blood sugar is mostly stable and the 3 month average is good then she can continue the same way. She has been increasing the Lantus dosage (now reached 35 units). I know male adults that take half that amount, but with Actrapid. Can she continue like that? Or, is it necessary to have the Actrapid injections for the body to be more like a normal person that secretes insulin when having meals? Or, is it okay as long as the girl is eating healthy food and controlling her blood sugar well? Any science behind the Actrapid? Any other information to enlighten us would be appreciated.

Answer:

It is difficult to answer such good questions without actually seeing blood glucose profile data, which means looking at blood sugar results before meals and about 2 hours afer meals for several days to see if there is some pattern plus a few blood sugars through the night. I’d also need to know something about islet cell antibody test results, A1c results and perhaps even a C-Peptide result to answer the question properly. The diabetes team may already have such information so important to ask them. Rarely, there are some young patients who have longer “remission” phases of type 1 diabetes but this is unusual with such a relatively high dose of Lantus and no fast acting insulin at meals. There are also other types of diabetes, not type 1, that might respond in this fashion as well. If the profile blood glucose data shows near-normal pre-meal blood glucose results and minimally elevated post-meal blood glucose data as well as near normal blood glucose through the night, then I would also agree that nothing needs to change and no Actrapid is needed. Similarly, if these values are all in or near target range, then this would be confirmed with normal A1c blood levels, too.

SB