Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
April 3, 2003
Question from Rome, Italy:
My 13 year old daughter, who has had type 1 diabetes for about two and a half years, is using Lantus as basal insulin, with NovoRapid for her meals. We give her Lantus at 8:00 pm so I can control her blood sugar at 11pm (when Lantus starts working) and give her 1 unit of NovoRapid if she is over 150 mg/dl [8.3 mmol/L] or 2 units if she is over 200 mg/dl [11.1 mmol/L]. We control her wake-up blood sugar quite well, and she is doing well till 5:00 pm when her blood sugar rises suddenly to over 200 mg/dl [11.1 mmol/L] which means that the Lantus is working just 18-20 hours. To cover the "insulin-hole" she gets a snack with a shot of NovoRapid. Her endocrinologist suggested to give her the longer lasting Actrapid for lunch to avoid another shot at 5:00 pm, but everything I read says that Lantus has to be used with NovoRapid so I wonder how to solve that problem.
Your daughter would greatly benefit from a mid-afternoon small (1-2 units) injection of any fast-acting insulin with no snack unless she needs it. This is a very good approach aimed to fill the basal rate gap that occurs late in the afternoon and causes the rise of blood sugar. The endocrinologist’s advice of your is also a good one, and it’s worth a try because the Actrapid (Regular) lasts longer than analogs and may control the mid-afternoon rise better thus avoiding the 5:00 pm shot. In my experience, your daughter might also greatly benefit in terms of blood sugar stability from a later (bedtime) injection of the Lantus (insulin glargine) perhaps at a larger dose for a more stable plateau over the 24 hour period.
[Editor’s comment: I am unaware of any recommendation from Aventis about what short-acting insulin should be used with Lantus.