September 7, 2004
Insulin
Question from Philadelphia, Pennsylvania, USA:
My 18 year old daughter has been using a pump for the last two years with good control. Her A1c was 6.5. She wanted to take a break from the pump and has been using 32 units of Lantus at night and NovoLog injections for meals. Her blood sugars are okay in the morning, but they are high everyday when she comes home from school. She increased her carbohydrate ratio for lunch, from 1:18 to 1:16, but she is still high. She corrects the highs and they come right down and her blood sugars are good in the evening. I have considered using a small dose of NPH in the morning, but I am unsure of how much to give her. She has just started school again and always needed more basal on school days when she was on the pump. When does the NPH peak?
Answer:
It seems to me that you are making it too complicated. I suggest you change the insulin to carbohydrate ratio a bit more and leave it at that. NPH is too variable. I doubt you can get it right and not have low blood sugars.
LD
[Editor’s comment: Please read a previous Diabetes Team question about splitting the Lantus dose to help prevent afternoon high blood sugars. In this answer, Dr. Brink indicates that some NPH might be helpful. However, it seems that splitting the Lantus dose might be a better first option. Be sure to consult with your daughter’s diabetes team.
BH]
