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July 24, 2002

Daily Care

Question from Duncan, Oklahoma, USA:

My four and a half year old son, who has type 1 diabetes, has erratic blood sugar readings that even his diabetes educators can't figure out. I'm not sure if he is still is in his honeymoon, because when he developed diabetes, he only needed a very small dose of NPH twice a day. However, his diabetes team switched him from NPH to Ultralente with Humalog at mealtimes. Since he was initially diagnosed, he has had a problem with waking up low, and none of the regimens we have tried have fixed this problem.He's now back on NPH (2 units at breakfast only). Can we use Humalog only (no basal insulin) before meals? I feel like his morning lows are due to the longer lasting insulins staying in his system longer than they are supposed to, and during the night, his blood sugar seems to take care of itself. Does anyone (other than pump users) use only Humalog?

Answer:

You don’t give us the “spread” of the glucoses, but I expect some are high and others low. I doubt you will be able to really control the diabetes with little bits of Humalog. This would require too many shots, likely cause many highs and lows, and certainly he will run out of insulin during the night. Maybe you should ask about using Lantus (insulin glargine).

LD