April 30, 2004
Hypoglycemia, Insulin Analogs
Question from El Paso, Illinois, USA:
My nine year old son was diagnosed 11 months ago. He takes Lantus at bedtime and Humalog with meals. Several times he has had low blood sugars one to two hours after meals. When we treated then with 15 grams carbohydrate, waited 15 minutes and his blood sugar remained the same, we treated him again. An hour or so later he would be very high, over 300 mg/dl [16.7 mmol/L]. Could it be that he digests slowly? Our endocrinologist said she had never run across that before. I started giving his Humalog after meals and it seems to prevent the problem. Any thoughts on the causes? Can giving his injection after meals cause any problems?
Answer:
This is not so uncommon and may reflect the timing of food absorption and timing of insulin absorption. Sometimes it relates to sites of injection. There is no problem with giving a bolus of Humalog or NovoLog insulin immediately after meals, if you can document that this works better. For me, documentation means very close monitoring of pre and postprandial blood glucose levels and close contact with your diabetes team to help you assess effects while preventing hypoglycemia.
SB
