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July 23, 2003

Daily Care

Question from Auckland, New Zealand:

My adult son, who has been using Actrapid [Regular] with Protaphane [NPH] injections for 10 years, and he is fairly well controlled, although not keen on testing. His doctor has suggested several times that there is a better type of insulin but he will not make the change, and I feel he is avoiding it since the new insulin may require frequent testing. Is it okay to stay on Protaphane with Actrapid?

Answer:

If your son has good diabetes control and is happy with the insulin regimen he is on, then there is no real need to change. I would suggest changing if there are problems.

JS

[Editor’s comment: To expand on what Dr Schulga said, there is good evidence that complications can almost be entirely eliminated by keeping hemoglobin A1c levels 6.5% or less. The higher the A1c. the more likelihood there is that your son will develop complications. So, if his control is not yet this tight, he should explore ways of reaching this goal.

The literature is quite clear that tight control is linked to the frequency of blood glucose monitoring; the more frequently, blood sugar levels are checked, the better the control. So it would be important to explore reasons why your son is not keen on testing. Most often there are either because the person does not want to see the numbers or that they find testing time-consuming and/or painful. Newer meters are quite fast (5-10 seconds in some instances) and those that employ Alternate Site Testing are essentially painless. Blood sugar numbers should not be viewed as good ort bad”, but rather as tools for making needed adjustments in the treatment plan.

Both basal/bolus insulin regimens and insulin pumps offer a great deal of flexibility in food choices and lifestyle. In addition, it is far easier to adjustment doses to control blood sugars more effectively and match insulin to food, exercise, etc.

I see that your son is an adult, and I think (if he is willing) it would be important for him to sit down with an experienced diabetes team to explore treatment options that would match both blood glucose goals and lifestyle choices. While I fully understand your concern as a parent, your son is an adult, and, unfortunately, you cannot dictate what he does. You can be supportive and provide guidance, however.

SS]