We switched my three year old daughter’s Lantus from evening to morning because of nighttime lows, and she currently takes 4 units with NovoLog at meals. We are noticing that her fasting blood glucose is consistently within range, then one to two hours later, she is high, but she comes down nicely or is even low before lunch. Her lunch postprandial blood glucose is within target, but her pre-dinner reading is consistently high even without an afternoon snack. Is it possible that NovoLog is taking that long to work? Could this indicate a need for more Lantus?

You may want to try Humalog to see if it is a bit faster than NovoLog to cover breakfast. Also, giving either before instead of after breakfast may give you better immediate coverage just after breakfast for a few hours. The late afternoon highs re a bit strange. Sometimes in very little kids, Lantus (insulin glargine) really does not last much at all. You could try some Humalog or Novolog to cover afternoon snack and this should work nicely, although using an extra injection shot, and also give you flexibility if there is change in activity as well as afternoon food. A small dose of lunchtime NPH is also a possible option for some afternoon/early evening coverage. We would make such decision all on the basis of blood glucose patterns and expected insulin responses.

SB