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March 13, 2005

Honeymoon, Insulin Analogs

Question from Istanbul, Turkey:

My 10 year old son was diagnosed with type 1 diabetes a month ago. We stayed in a State hospital's children endocrinology division for eight days. My son uses pens and started to inject NovoRapid, three times a day and Lantus in evenings. We have had to adjust his insulin often because he was having hypoglycemic reactions. I telephoned the doctor and they decreased the insulin level. Then, one week ago, we began to skip injecting NovoRapid in the evening and inject only one unit of NovoRapid in the morning and one unit at noon, with four units of Lantus at 6 p.m. But, he continued to have low blood sugars at school and his 6 p.m. reading was 35 mg/dl [1.9 mmol/L]. Three hours after dinner, it was so low that we couldn't measure it with our MediSense Precision QID. For two days, we have been injecting only three units of Lantus in the evenings. His glucose rates are in range and even low. This morning, his fasting sugar was 69 mg/dl [3.8 mmol/L]. Two hours later, he was 150 mg/dl [8.3 mmol/L]. I understand that my child is in remission. They tell me that, during remission, it is better to give insulin to him. Is giving only Lantus okay or should I give him one unit of NovoRapid in the mornings and two units of Lantus at evenings? He is a very active boy, runs and plays all day in school, and follows his diet very well.

Answer:

In the honeymoon phase you may use either basal insulin alone or with fast acting insulins before meals also depending on the trend of blood sugar levels over the day, fasting, before and after meals. In your son’s case, being also so physically active, I’d advise you to keep on Lantus only, always injected at dinnertime in the buttocks. Fast acting may be added when he’s not active or when extra food is eaten, whenever it can contribute to higher postprandial values. As this lucky “honeymoon phase period” will fade and puberty will get closer, this strategy will be shaped to the new and higher insulin needs.

MS