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July 31, 2011

Daily Care, Insulin Analogs

Question from Karachi, Pakistan:

My 11-year-old son was diagnosed with type 1 diabetes after being in DKA. Can he use Lantus along with his short acting insulin? He weighs 25 kg (55 pounds). Is there is any harm in using Humulin 70/30, which he is using now?


From: DTeam Staff

The 70/30 Humulin that has been prescribed is a previously mixed, by the manufacturer, insulin suspension that contains 70% of intermediate-acting NPH insulin and 30% faster-acting Regular insulin. This is a very convenient premixed combination and typically allows an insulin and meal plan that consists of two shots of insulin daily plus three meals and three small snacks that typically are set at specific times of the days with specific doses of insulin and specific calorie intakes.

This plan is tried and true. But, the biggest disadvantages is that it assumes the patient’s insulin needs are 70%/30% of intermediate and short-acting insulins. An INDIVIDUAL’s insulin needs hinge on meal planning, their overall health status, activities, etc. Certainly the capacity that the child and caregivers have for mixing insulins or providing a more sophisticated insulin plan play a role, too.

The use of Lantus (as a long-acting insulin) in combination with a short or even rapid-acting insulin is a very good insulin plan. In this plan, the Lantus acts as a “background” or “basal” insulin and the rapid-acting insulin is given with each meal/snack, according to the physicians specific instructions. The advantages of this plan include that it is not so regimented or strict in terms of when and how much calories are consumed at meals and that it better mimics the normal physiology of insulin action. On the other hand, multiple injections of insulin and multiple glucose checks are required daily. Furthermore, Lantus generally is recommended not to be mixed in the same syringe as the rapid-acting insulins. Special attention to the amount of calories or carbohydrates is absolutely required because this is how the dose of rapid insulin will be calculated for each meal/snack.

I presume that your child was recently diagnosed with diabetes. Hopefully, you can get some input from a specialist in pediatric diabetes care to help you work on what type of insulin plan is best for you all right now. At this stage of the diagnosis, as you hope to enter the “diabetes honeymoon,” it probably matters less as to what insulin plan you are following, as long as there is good attention to meal planning, exercising, and proper administration of the prescribed insulin with careful attention to glucose checking at home.