June 23, 2007
Daily Care, Insulin Analogs
Question from Edinburgh, Scotland:
My son is on 16 units of Actrapid and 32 units of Insulatard in the morning, 14 to 16 units of Actrapid before tea and 14 units of Insulatard before supper. His A1cs have averaged 8. The clinic would like my son to go on glargine and NovoRapid. Are these insulins as safe as the Actrapid and Insulatard? He is happy with the insulin he takes, but would like to have more control over when he eats. The clinic was offering the new insulin to us without any training of carbohydrate counting. I have always counted the carbohydrate content of each of his meals, but was told by the clinic not to do this as this would cause him to be anxious and the overall control would not benefit him. I have since been told that this is negligent information. I read that NovoRapid and glargine can cause water retention. I would be grateful if you could advise what the safest insulin is. My son is 6 feet, 4 inches, 162 pounds. What is the safest amount of insulin to take per day? Can you take so much insulin in a day? The clinic have told me there is no limit to how much insulin to take in a day.
Answer:
I fully agree with your son’s clinic team to switch him to glargine and aspart (NovoRapid). Both insulins are quite safe, as are all the insulins on the market, and there is no problem at all with water retention that is actually a possible effect of any insulin due to its sodium sparing effect. Moreover, both are much more physiologically closer to the needs of human body in terms of faster absorption (aspart) and longer and peakless duration of effect (glargine). On the other hand, I don’t agree regarding the “negative” issues raised by the clinic’s team on the carbohydrate counting, which I consider one of the most important determinants of a good metabolic control. Actually, it is very useful in decreasing anxiousness and helping a young patient to cope with the everyday changing heating habits.
There is no fixed dosage of insulin as it depends on many factors such a physical exercise. In your son’s case, the adolescent spurt may actually increase abruptly the required dosage of insulin even though an average dosage may range between 0.5 up to 1.5 UI/BW/day.
MS
