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July 7, 2004

Daily Care, Insulin

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Question from Spencer, Nebraska, USA:

My 13 year old son has had type 1 diabetes for 10 years. We have been using Lantus, NPH, and Humalog insulin. We have been avoiding a noon shot. His last two A1cs were 7.5 and 7.7. The last two months, his blood sugar has been out of control. Our current diabetes team wants to start shots at lunch. My son does not want a shot at lunch at school. Is there any way to make this work? My son is 5 foot 8 inches tall and weighs 115 pounds. What would the average doses of Lantus and NPH be to avoid the lunch shot?

Answer:

A lot of diabetes management hinges on trying to balance insulin dosing with meal planning and activities. The “only” way to know if a lunchtime shot of insulin would be of benefit, or not, is to try. But, some things clearly are already being done to try to avoid a shot at school, such as the use of NPH at breakfast time.

Again, depending on your pubescent teen, and his activities and meals, one might estimate a daily dose of Lantus to be about 25 to 35 units per day. I still prefer to give Lantus at bedtime. If the fasting glucose is good in the morning, the dose of Lantus is probably near the target. I presume you dose the Humalog based on carbohydrate intake and the dose of NPH given in the morning is a fixed dose.

Does your son routinely eat breakfast AND a mid-morning snack and then he is high at lunchtime? Or, is he mostly high in the afternoon after school and towards dinner? If the former, then maybe Regular at breakfast would be better than Humalog. If no snack but still high at lunch, a hint of Regular, in addition to the usual morning insulin “cocktail” might still be the answer. If the latter, then I think an increase in the morning NPH or the use of Lente may be reasonable.

Is an insulin pump not on the radar screen? Continue to work with your Diabetes Team.

DS