October 16, 2003
Insulin Analogs
Question from South Carolina, USA:
My 11 year old daughter, diagnosed two months ago, was recently switched to Lantus with NovoLog, and since then, her blood sugars have steadily came down (although still running a little high), and she has had had no more extreme lows, thankfully. She was doing a bedtime dose, which was changed to morning to avoid some lows in the night. However, she is now running high overnight (over 350 mg/dl [19.4 mmol/L]), and her blood sugars during day range 150-220 mg/dl [8.3-12.2 mmol/L]. In addition, she has trace to small urine ketones all the time, even though she is drinking lots of water.
When I ask the nurse practitioner what should I do about dosage changes etc., she also asks me what I want to do. I know this is supposed to be individualized but hey, I’m not that comfortable yet. I’m really trying to feel our way through this maze of uncertainty. Does she need more Lantus? Can you split up Lantus (morning and evening)? Should I cut out the bedtime snack? I welcome any suggestions.
Answer:
Many youngsters and some adults need a split Lantus dose. The key is to do lots of blood glucose monitoring and figure out where the Lantus and the bolus (rapid acting insulins) are working and then add the second dose. Most seem to need more bedtime Lantus and a small amount of morning Lantus, but some need an opposite program. Some also do well with bedtime Lantus and a small dose of lunchtime NPH.
Go back and discuss this with your daughter’s diabetes team and ask for consultation with the physicians as well as the nurses if you feel that you are not getting sufficient assistance. They also need to know how often the ketones are positive since this is also not a normal situation.
SB
