March 16, 2007
Daily Care, Insulin Analogs
Question from San Diego, California, USA:
My daughter’s pediatric endocrinologist is suggesting a new insulin regimen to include Lantus, NPH and NovoLog. She is currently taking NPH and NovoLog and is out of control. Her last A1c was 9.1. We are not sure if she is out of the honeymoon yet or not. She has a very limited diet due to the fact that she is also lactose intolerant and during the food elimination process to track what was happening to her, she did not accept some of the foods she previously had eaten when they were reintroduced. She is six years old and receives NPH/NovoLog at breakfast, NovoLog at dinner NovoLog and NPH at bedtime. I have never heard of this type of treatment before and would like to know what advantage/disadvantage it may have. She is not a candidate for an insulin pump due to dermatology issues. We are currently awaiting an appointment.
Answer:
The addition of Lantus provides another “background layer” of insulin. Lantus does not have the peaking and waning effects of NPH.
While a more classic “basal-bolus” insulin plan would suggest a long-lasting insulin, like Lantus as the baseline/background/basal insulin and then a rapid-acting insulin, like NovoLog to be taken with virtually EACH food intake at meals/snacks, this would require a six-year-old to get a shot of insulin at lunchtime at school, which may not be convenient. The continued use of NPH at breakfast might obviate the need to take the mealtime NovoLog at lunch.
I’d bet, given an A1c of over 9%, that her “honeymoon is over.” In my experience, the typical diabetes honeymoon only lasts one to one and a half years.
DS
