Our six year old daughter, diagnosed at 18 months with type�1 diabetes, is now on three shots of insulin a day to improve her control in the early morning hours. We are struggling to determine what the best mix and timing of these shots should be. Is it best to divide the nighttime long-acting insulin (NPH) between the dinner and bedtime shot? Would it be more effective to give all the NPH at 11:00 pm rather than bedtime (8:30 pm)? We always test prior to the injection, but are concerned that the 8:30 pm test is only two hours after the last injection. What is the usual three shot regimen when using a mix of Humalog and NPH?

The traditional way is the three shots with NPH and Humalog in the morning, Humalog at dinner, and NPH at bedtime. I haven’t split the supper and evening NPH, but everything is possible.

I have had some success taking the new 75/25 insulin and using a syringe to take some insulin from it. I then give the insulin three times a day (morning, midday, and after supper). This seems to work fairly well and protect from lows in the night.

LD

[Editor’s comment: There is no “best” insulin program. It’s simply a matter of what you and your diabetes team find works for your circumstances, in terms of lowering the HbA1c without causing excessive hypoglycemia. Usually this means several shots a day of several kinds of insulin, but even this concept is only a guideline.

WWQ]