September 2, 2001
Daily Care, Insulin Analogs
Question from West Dundee, Illinois, USA:
Our three year old was diagnosed with type 1 diabetes at age 15 months and has several lows a week on Humalog and NPH mixtures. What is your opinion of using Lantus for a three year old child?
We often use smaller doses of overlapping NPH coupled with diluted Humalog in such very young children with good success. We give Humalog and NPH before breakfast, Humalog and NPH before lunch, Humalog alone before dinner, and NPH alone very late in the evening. Still, there are many ups and downs in toddlers because of erratic insulin effect, erratic food intake, erratic activity and many other unknowns.
That said, while Lantus (insulin glargine) is not yet cleared by the FDA for use in children under age six, it is likely that it will be tried to see if clinically useful. You should discuss this with your diabetes team and, if the risks of persisting frequent hypoglycemia are still occurring despite your and their best efforts, it may be worthwhile to try Lantus to see if there is added benefit. There are some anecdotal reports that Lantus alone at bedtime may not work the same in very young children as in older kids and adults so that there may still be some need for NPH. We would make such decisions empirically based on lots of blood glucose readings looking for patterns and then responding accordingly.