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April 10, 2004

Daily Care, Insulin

Question from Norwalk, California, USA:

My daughter's insulin dose has been going up a lot lately. She gets 50 units NPH, 22 units of Regular in the morning. She takes a spot dose at lunch with NovoLog, 23 units of Regular at dinner, and 12 units of Lantus at bedtime. She is low in the mornings 50 or 60 mg dl [2.8 or 3.3 mmol/L]. We treat it, then give her shot when she is over 70mg dl [3.9 mmol/L]. At lunch time, she is high 240 to 300 mg/dl [13.3 to 16.7 mmol/L] and at dinner she is also 240 to 300 mg/dl [13.3 to 16.7 mmol/L]. She is 5'6" and 136 pounds. Her A1c was 6.7 a week ago. Are these insulin doses very high for a girl her age? Is she becoming insulin resistant?

Answer:

The insulin requirement of your daughter is quite high for a girl her age and her weight and it seems that insulin doesn’t work well. I don’t know if she is becoming insulin resistant or if the insulin schedule should be revised. I think that she should revise her insulin regimen with her diabetes team, using only glargine (Lantus) as long acting insulin, injected at bedtime only or at bedtime and before breakfast. If this does not work you can discuss using metformin plus insulin.

AS