January 2, 2002
Insulin Analogs
Question from Plummer, Idaho, USA:
My seven year old daughter, who has had diabetes since she was four, switched to a Lantus and Humalog regimen about five months ago, and things were great for a while, but now it seems her blood sugar rises in the afternoon. I test her when she gets home from school (4:00 pm), and she is usually no higher than 150 mg/dl [8.3 mmol/L], but however by dinner (5:00-6:00 pm), she is usually in the 200-300 mg/dl [11.1-16.7 mmol/L] range having eaten no additional carbs since lunch.
I read on a chat transcript that it is possible to split the Lantus dose, giving the nighttime dose and a dose equal to half the nighttime dose in the morning. Would this be helpful in her situation? I read that it could just be that her basal needs are higher in the afternoon (which seems likely to me because of a decrease in activity), but is splitting the Lantus still a viable option?
Answer:
You can split the Lantus (insulin glargine) dose and give some in the morning. This would mean giving two separate injections for breakfast, however, since you cannot give the Humalog in the same syringe as the Lantus. We see this quite frequently and either give a booster of Humalog at 3:00 pm or add a small amount of NPH to the lunchtime Humalog dose. This has worked very nicely with many of our pediatric/adolescent patients where the Lantus does not last more than 18-20 hours.
SB
