Our eight year-old son has had diabetes since the age of three.

Your suggestion, in response to a previous question, to give Humalog with NPH before each meal and then NPH at bedtime is not something that our pediatrician has discussed with us. Would an injection of Humalog and NPH before his noon meal put him at risk for lows in the afternoon? I would be hesitant to load him up with more NPH at noon, fearful that it would be too much combined with the carryover effect of his morning NPH. A small amount of Humalog at noon would make sense to me, however.

The rationale for a mixture of lispro with NPH before each meal is to extend the shorter duration of lispro (compared with the Regular) long enough to the next meal, especially in children who commonly have snacks between major meals. Then/ you need first to closely monitor your child’s blood sugar before and two hours after each meal starting with mixtures of small doses of both insulins and adjust acording to the results. If his blood sugar during afternoon until supper is fine, even at a very low dose of NPH at lunch, then you may stop it, continuing with lispro only.Then, see whether the good blood sugars persist before dinner. In my experience with children, this hardly happens, and I prefer to mix small doses of NPH with lispro before each meal eventually decreasing the dose of lispro.

MS