My 12 year old daughter has type 1 diabetes and her A1c for the past two quarterly checkups has been 6.3. Before this, she was averaging about 8.0 to 8.4 for the previous two years. Since she was diagnosed with type 1 diabetes, she has been taking a combination of NPH and Humalog injections. Now, her care team is suggesting she change to Lantus and Humalog so she can better control her blood sugars. Her daily blood sugar numbers fluctuate quite a bit with no real pattern to the highs and lows, but, with an A1c of 6.3 for the past six months, do you feel we should switch her insulin program? In general, does Lantus and a fast acting insulin combination work better for a 12 year old than NPH and Humalog?

You should really ask this question to your diabetes team since they would be able to give you a specific answer for your child. In general, many diabetes teams have switched to using Lantus as a basal insulin since it has fewer peaks than NPH (or Lente or Ultralente, in the past) and more predictable response. Often, two shots of Lantus are needed and, occasionally, just a morning shot of Lantus instead of the usual bedtime shot of Lantus. All this should be determined individually by detailed blood glucose profiles and coupled with prandial rapid acting analogs to mimic the basal-bolus insulin delivery of the pancreas. Most importantly, this helps decrease overnight hypoglycemia and improve morning and post-breakfast hyperglycemia when the bedtime (usual) Lantus has a small peak. But, go back to your team and find out why they suggest such a change.

SB