September 28, 1999
Question from Iowa, USA:
My four year old daughter was diagnosed one month ago with Type 1 diabetes. They initially had her on Regular and NPH with two shots a day. We decided to switch to a endocrinologist who suggested switching her to Humalog and Ultralente with 3 shots a day. However, her blood sugars are progressively going up at supper time despite the fact that I keep raising her dosage at lunch time. Is it possible that Humalog is effective with her? Or is it just a matter of continuing to up her dosage? Is just seems that her lunch shot doesn't budge her sugar levels.
The phenomenon you describe of an upsurge of blood sugar starting late afternoon and peaking before suppertime is becoming more and more common with the widespread use of intensive regimen based on fast acting insulins, such as lispro insulin [Humalog� brand], before meals and NPH/Ultralente at bedtime as basal coverage. It is secondary either to its shorter half-life of lispro as well as to the waning of the NPH/Ultralente of previous night. This is why we sometimes mix either Regular or NPH with lispro at lunch in order to prolong the effect towards suppertime. If this doesn’t budge sugar levels before suppertime, a shot of not more than 2-3 units of lispro/Regular in the middle afternoon may help.