My son has had type 1 for two years. His blood sugars are out of control. He has readings from 500 mg/dl [27.8 mmol/L] down to 35 mg/dl [1.9 mmol/L] in one day. I’m having to force him to eat. He is currently on nine and a half units of NPH and two units of NovoLog at breakfast. At dinner, he gets one and half units of NPH and two units of NovoLog. He also gets one unit of NPH at 11 p.m. I get no help from his CDE. She says I should know how to do everything by now. I’ve been trying for the last year to get him on Lantus, but his doctor flat out refuses. Any advice on what I can do to help my son would be greatly appreciated.

I would recommend working with your doctor and the CDE to get your child on carbohydrate to insulin ratios and a corrective dose for breakfast and supper. Even if the endocrine practice is not yet comfortable with Lantus for very young children, that would still offer you a great deal more flexibility.

You also may want to discuss with the CDE “re-splitting” out your child’s NPH. Sometimes very young children, like your son, end up on very high morning doses of NPH and very low overnight doses. This could be the correct dosing, but sometimes re-splitting the insulin (to try to give more like two-thirds of the total daily dose in the morning and one-third in the evening hours) helps when you’re having erratic highs and lows due to variable absorption of a large bolus of morning NPH.

Once Levemir insulin becomes available, that might be another option in lieu of the NPH. I have no personal experience with Levemir, but it looks as if it may be able to replace NPH in some children since the clinical study data looks as if it has a pretty predictable peak.

LAD