Is there a “standard” treatment for kids who have developed diabetes? Specifically, I’m wondering about the NPH/Humalog combination that my niece, who has newly diagnosed diabetes, is taking. As an adult with diabetes, I took a long acting/short acting combination like that years ago, and was, truthfully, not all that happy with it. Now I take Ultralente and Humalog and get good results with it.

While I was on vacation with my niece, I watched her eating snacks (even though she wasn’t hungry), getting woken up several times during the night to check her sugars, (her “reward” for good sugar readings) and eating like she was on military time, but never getting the control I have with her sugars. I realize that she is 11 and I’m 41, but I wonder why she (or any child) gets put on insulin with a peak like NPH. Is there some reason that kids shouldn’t take non-peaking insulin? Wouldn’t that be more flexible for a child?

There is no standard insulin regimen that fits everyone. However, it is most common, when aiming for tight control to, use multi-dose insulin regimens. At our center, we suggest overlapping doses of NPH, often three or four times each day so that we do not need large doses at any one time, coupled with bursts of Humalog pre-meals, and, sometimes, also pre-snacks. This mimics what the pancreas was doing before diabetes wiped out the beta cells.

However, there are many people who recommend the program you are using with such good success using Ultralente once or twice and then bursts of Humalog. In Europe, especially with Italian style eating times, Lente seems to work better than NPH. All this is extremely individualistic and must be centered around blood glucose data rather than guessing. Ultralente, for many people, also has a peak and is somewhat unpredictable in how it works. So, don’t be too critical with your relatives. Ask, however, about severity and frequency of hypoglycemia, HbA1c levels, and whether or not they have tried (or thought about) alternative approaches with their diabetes team, since this may actually answer the questions you pose.

SB