My four year daughter has had type 1 diabetes for less than two years, and recently I went to a diabetes association meeting where I was informed of a new insulin. I was told informed that there is less chance of hypoglycemia with it, and it is very much similar to using an insulin pump. Could you please let me know more information about this insulin?

Your friends are probably talking about Lantus (insulin glargine). This is a relatively new insulin from Aventis. Glargine is a synthetic human insulin whose molecule is manipulated to make it last longer and somewhat smoother than other insulins. So it is used as a new basal insulin much as one would use basal insulin an insulin pump. In some people it lasts a full 24 hours and is coupled with Humalog or Novolog.

The Fast acting analogs, Humalog and Novolog, provide bolus coverage for meals and snacks and the basal insulin effect comes from the glargine. In many people, the glargine does not quite last 24 hours and can be given in the morning as well as the evening or even at other times of the day. It all depends individually on the actual blood glucose response.

We usually use Humalog pre-breakfast, Humalog plus NPH pre-lunch, Humalog pre-afternoon snack and Humalog pre-dinner with Lantus at bedtime. We are not dogmatic about exactly when the insulin should be given, but only that it should be matched with actual blood glucose information before and after food plus some overnight monitoring.

You should discuss this with your daughter’s diabetes team since there is not a lot of information about using Lantus in very young children. It is also not officially “approved” for those under age six since so few studies have been done.

SB