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July 25, 2018

Insulin

Question from Brookfield, Connecticut, USA:

What is the best insulin for an eight-year-old child? Our diabetes specialist prescribed Toujeo, which looks like has not been tested on people under 18. Furthermore, the Sanofi site specifies that Toujeo should not be used in children. So, what are the potential consequences of continuing to use Toujeo? What is a better brand/type of insulin to switch to for long-lasting (morning) injections?

Answer:

Toujeo and Tresiba are newer basal insulins that look like they produce less hypoglycemia, especially overnight hypoglycemia, work a bit longer and smoother so are replacing former basal insulins (Lantus, Levemir) used in MDI (multi-dose insulin) regimens with meal-time (prandial) Humalog, Novolog or Apidra. Basaglar, a “bio-similar” to Lantus glargine also looks like it produces less hypoglycemia and has fewer peaks than Lantus so similarly is being used as a Lantus replacement by many diabetologists for adults as well as children and adolescents. Initial studies show all of these to be safe and with similar benefits and side effects in kids as well as adults. Toujeo is less likely to be used in kids unless there is significant obesity and insulin resistance with very high basal dose requirements because it is a more concentrated form of basal insulin. So, basaglar and Tresiba are most likely to be used in MDI basal insulin regimens.

SB