March 29, 2000
Question from The Netherlands:
Our daughter, born 18-01-95, diagnosed 05-98, just started to use Humalog Mix25. Are there any experiences using this type of insulin at young children?
If you search under ‘Humalog Mix25’ in PubMed you will find a small number of reports on the use of this 1:3 mixture of Lispro and NPL insulin. In adult diabetics who have been using premixed regular/NPH insulin it seems to give more even between meal glucose control and a somewhat reduced incidence of hypoglycemia. So far as I know, the product is not yet approved by the FDA for general use in the US though there have been extensive clinical trials.
I think that it will be some time though before you see reports on the use of Humalog 25 and Humalog 50 in small children. The reasons for this are first of all that lispro itself is not yet approved by the FDA for children although of course it is widely used and the reason for this is primarily the huge cost of official clinical trials. Secondly there is generally less enthusiasm for using fixed mixtures of short and medium acting insulin in children: with the pressures for ever more exact control there is an increasing tendency now to use Lispro after meals so that the dose can allow for the premeal blood sugar as well as for appetite and a long acting insulin in the morning or at bedtime. Glargine is another evenly released substituted insulin whose role in childhood has not yet been established. In looking to the future for little children it seems clear that insulin pumps will be used more and more even in six year olds and that this tendency may increase if non invasive blood glucose monitors come out soon with smaller versions. Meantime I know of no ill effects from NPL insulin and as always it is the hemoglobin A1c level that determines success.