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September 21, 2016

Daily Care, Insulin Analogs

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Question from Weimar, Texas, USA:

My son was diagnosed with type 1 diabetes one week ago. He takes a shot of Lantus and Humalog in the morning, Humalog with lunch, and Lantus and Humalog with dinner. Is it okay to skip the dinner shot of Humalog if he doesn’t want to eat dinner because he got up late and ate breakfast late, which pushed his lunch late to 5 p.m. He isn’t hungry for dinner so can he just do a snack, and what would your recommendation be for the evening/dinner shots of Lantus and Humalog? Should he force himself to eat a late dinner at 9 or 10 p.m.? He consumes 60 grams of carbohydrates for breakfast, 90 grams for other meals.

Answer:

It is somewhat dangerous to get up so many hours later than usual because of the night before insulin dose still peaking. While Lantus was designed to be a steady insulin, there is evidence that 60% of those who use it experience a peak between 12 and 16 hours after injection. Given at bedtime, Lantus peaks a bit pre-breakfast and post-breakfast to help with the dawn phenomenon. You should discuss this with your diabetes team for more individual recommendations.

If there is no meal at the usual time, then it is perfectly reasonable to reduce the fast acting insulin for that meal and just use correction dose for blood glucose readings at that time. But, the same problem will be the “missing” food to counteract the still present long acting Lantus effects. So, risks of both higher and lower blood sugars persist from being off schedule any time this occurs. The most flexible option for irregular eating remains an insulin pump because the basals are lower, adjusted hour-by-hour instead of 12 to 18 hours blocks and with more flexibility for bolus meal/snack doses as well.

SB