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September 10, 2004

Insulin

Question from Bellmawr, New Jersey, USA:

My three year old was diagnosed a few months ago, so this is new to me. Anyway, my daughter's endocrinologist recently switched her from NPH to Lantus, and I don't see how it is helping her. Actually, it seems like her readings are higher than when she was on NPH, but, at night, her sugar is dropping anywhere from 57 to 62 mg/dl [3.2 to 3.4 mmol/L]. I haven't seen much consistency at all, and was wondering is this due to her insulin dosing or her age, as I've been told?

Answer:

A number of factors must be considered: Is you daughter still making insulin herself at night? Is the current insulin regimen optimally tailored for her (almost certainly not)? Have you been given enough information to make sensible adjustments (probably not)?

I cannot comment on individual insulin regimens, but there is nothing amiss in the principle of using Lantus rather than NPH, in fact, there is evidence that this should reduce, not increase, overnight low blood sugars. You must discuss all of the above with your daughter’s diabetes team and share with them your concerns.

KJR