My eight-year-old daughter was just diagnosed in February 2008. She is on NovoLog/Lantus injections. Right now, we space her NovoLog injections always at a minimum of three hours apart. I have read that some people don’t always do this and they overlap. Is there a specific formula a person uses if they overlap fast acting insulin? Is it wise to overlap like this or is it standard to just stick with the three hour rule normally?

If your child’s glucose values and A1c levels are well controlled, and the injection routine that you are using is easy for you, then I see no strong reason for making a change. Having said that, I am uncertain that spacing the rapid-acting insulin “three hours apart” really is the physiologic mimic that a basal-bolus plan sets out to do. For a person without diabetes, there is the “continuous” background of insulin plus additional insulin based on the calories taken in. For a basal-bolus plan by injection, giving a shot of rapid-acting about one to two hours after the meal, taking into account what they ate (plus taking into account the current glucose value, seems wiser.

Now, if you then advance to an insulin pump, you can modify the pattern in how the bolus/mealtime insulin is given, whether that is a “spike” bolus (like a shot) or a more prolonged infusion. These more advanced methods can be very helpful for different types of meals or situations.

DS