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September 9, 2003

Daily Care, Insulin

Question from Pennsylvania, USA:

My 13 year old son was recently diagnosed with type 1 diabetes and is very bright, responsible, athletic and active. What is your opinion about a regimen of NPH with Humalog at breakfast and dinner? What is your opinion about this three-shot insulin plan: Humalog and NPH at breakfast; Humalog and NPH at dinner; NPH at bedtime? I have talked to many people who use Regular with NPH. Can you tell me a little about Regular? I am not certain as to why it was indicated to us while my son was in the hospital that they (doctors here) no longer use it. It seems the current endocrinologist doctors and nurses here do not advocate Regular. However, I have chatted with several people who continue to use Regular with NPH and have good results. Just curious.

Answer:

The two shot regimen is conventional but beginning to be superseded by Humalog just after every meal varying the dose with the pre meal blood sugar and the carbs consumed and Lantus at bedtime or in the morning. I don’t see the point of giving three shots of NPH when you could give one shot of Lantus.

Regular insulin is nowadays a biosynthetic human insulin and for many years two daily injections before breakfast and supper was the standard regimen for children and teenagers. Humalog or Lispro are very similar insulin analogs, that has a minimal rearrangement of the amino acids at one end of the B chain of the insulin which leads to an action that much more exactly covers the normal pattern of blood sugar rise after a meal.

DOB