My 13 year old was recently diagnosed with type 1 diabetes and is using N and R insulin. A person with long-time diabetes told us that R insulin is a thing of the past and is no longer used. Is this true?

Insulin type should be chosen according to what is available, affordable and the what the goals of therapy are. We routinely use fast acting insulin analogs (usually Humalog and, more recently, Novolog also available in the USA) since this mimics physiology better than previous insulin regimens, provides better postprandial blood glucose control, helps decrease hypoglycemia, and is more convenient ( it can be used immediately before eating without having to wait for 30-60 minutes). We have had great success with this regimen using Humalog before meals and then overlapping doses of NPH (could be Lente or Ultralente as well) to provide basal insulin effects. We have almost completely stopped using Regular insulin since the tail effect is longer than we desire, is associated with more hypoglycemia, and must be used by waiting 30-45 minutes before eating. Some other groups use combinations of analog and Regular insulin, but we have not chosen this therapeutic path.

You should go back and discuss this in some detail with your diabetes team.

SB