Question from Lake Oswego, Oregon, USA:

My 4 year old son has had Type�1 diabetes since he was 21 months old. We use a combination of Humalog and NPH in 4 to 6 injections a day. As a general rule, he needs about.75 units of Humalog per exchange of carbohydrates. Injecting with a meal works great because the action of the Humalog coincides with the release of glucose into the bloodstream from the carbohydrates.

Fats are another matter entirely. Oftentimes, he has a peak 2 to 3 hours after a meal, long after the Humalog has done its duty. Obviously, we don’t count the fat grams when we calculate a meal-time injection because he would just crash. But we frequently have to give a second shot about 3 hours after a high fat meal to bring his blood sugar into acceptable range. Can you offer an alternative injection strategy for dealing with fatty foods? We avoid fatty foods as much as possible. But, hey, he’s a kid first, and sometimes that means pizza. How about a mixed shot of Regular insulin and Humalog?