November 29, 2000
Question from Briarcliff Manor, New York, USA:
My eight year old son was diagnosed with type 1 six months ago. Do you have any information on how a cocktail of NPH, Regular and Humalog works? According to an [an insulin manufacturer] there have not done any clinical trials on mixing the three together.
For the past few weeks (and with my doctor’s consent) I have been giving him a morning “cocktail” of NPH, Regular and Humalog to help avoid mid-morning highs (200-300 mg/dl [11.1-16.7 mmol/L])) and have a pre-lunch reading preferably below 140 mg/dl [7.8 mmol/L]). We use a sliding scale with 6 units of NPH, 1.0-2.0 units of H and 0.5-1.0 units of R. The highs have been a bit better, but, many times, my son goes low before lunch (in the 60s mg/dl [3.3 mmol/L]). It is my understanding that NPH mixed with Humalog can delay its onset, therefore would I be better off taking the R out of the morning cocktail since the Humalog is not kicking in until a bit later anyway?
I am unaware of any studies done that involved large numbers of patients who mixed the insulin as you do. If you are having success mixing it this way, I would not necessarily change. I would suggest, however, that it is going to become difficult to tell which insulin is providing a benefit to your son when you mix three insulins together. Whichever way you decide to mix insulins, I would discuss it at length with your diabetes team and utilize them frequently to assist you in making changes to provide for your son’s needs.