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February 15, 2003

Insulin

Question from Flin Flon, Manitoba, Canada:

My son was taking NPH with Humalog, but the diabetes team changed it to a mixture (25/75) because I was having problems getting him to do two injections at a time. Lately, however, his numbers have been high any way so we are doing corrections with just Humalog. Many people can't understand why the endocrinologist made this change and say that mixed insulin is not good for a teen with type 1 diabetes. Is this a good insulin for him?

Answer:

It sounds like the premix insulin doesn’t work so well for your son. This has been our experience for many years so we do not usually recommend such fixed mixture. Others in Europe have had more success but usually this means a more regimented meal plan and schedule.

I would usually recommend a multidose insulin regimen or an insulin pump to provide maximum flexibility and rely on bolus control with Humalog or NovoLog insulin and then some other type of insulin (Lantus (insulin glargine) once or twice a day, overlapping NPH doses, glargine at bedtime plus NPH at lunchtime) to provide basal insulin effect. All should be based upon hemoglobin A1c goals and actual day to day glucose readings before and after eating. It sounds like the goals are not being met. Go back and discuss with your diabetes team and re-set goals.

SB