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October 4, 2001

Daily Care

Question from Santo Domingo, Dominican Republic:

My five year old son, diagnosed with type 1 diabetes about 20 months ago, is having difficulty with control. Why is it that when he was recently diagnosed we could manage perfectly with NPH alone at breakfast and dinner, and now we are giving less NPH, be we have to add Regular at breakfast and lunch? Will he be able to go back again to only NPH in larger doses or will he have to combine NPH and Regular forever?


The definitive treatment in a five year old child is generally Regular or an analog Humalog or Novolog) plus NPH, Ultralente or Lantus (insulin glargine). That’s what is called an “intensified insulin regimen” based on fast acting insulin before each meals plus a slow acting insulin as basal. This regimen has been proved to be the best way to achieve optimal metabolic control and provides the best quality of life both of which are our major goals. Ask your son’s diabetes team about this regimen.


[Editor’s comment: At the time of diagnosis, your son was most likely still producing some insulin, but at this stage, your son’s honeymoon is ending which means his insulin requirements both is terms of type and dosage have to change. The important thing, as Dr Songini has said, is to aim for the best possible metabolic control. The regimen he describes is more like how the pancreas would function if the beta cells cells were intact.

I suggest that you do a lot of monitoring (before and two hours after meals) and discuss all possible treatment options with your son’s diabetes team. It is extremely doubtful that he will be able to achieve and maintain good control on NPH alone.