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January 17, 2006

Insulin

Question from Kentucky, USA:

My daughter takes Humalog and Lente insulin at breakfast and dinner. Lente is being discontinued. Lilly says another insulin will work fine, but I am hearing from parents that it does not work for the same 12 hours Lente did and the children are having nighttime lows. Can you share suggestions of insulin routines, including types of insulin, that can be substituted for Lente? We have enough Lente to last three months. We see the doctor in one month. We have been able to keep her A1c in the 7.0 range. I am concerned about nighttime lows and maintaining a good A1c level.

Answer:

It is true that Eli Lilly Company has discontinued the manufacturing of Lente insulin since the summer of 2005 and it was expected that pharmacy supplies would be depleted by December 2005.

The onset and peak actions of Lente insulin are very, very similar, but not the same, as NPH insulin. NPH “peaks” about six to eight hours after administration and Lente a little later and lasts, perhaps, a little longer.

In my experience, for most, but certainly not all, patients, one can switch from one to the other without too much disruption in schedules.

You indicate that you are dosing Lente and Humalog at breakfast and dinner. You may find that “splitting” out the evening dose of NPH to bedtime (YOUR bedtime, around 10 or 11 p.m.) may allow avoidance of middle-of-the-night lows, since it will be allowing a delay in the onset and peak action of the NPH. You may need to perform some 2 to 4 a.m. glucose checks when you switch.

This may also be the opportunity to confer with your diabetes team about switching to a basal-bolus insulin plan and use Lantus, an essentially “peakless” insulin as the background, long-acting, “basal” insulin.

Please make no changes without conferring with your child’s doctor.

DS