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May 12, 2003

Daily Care

Question from Rockford, Illinois, USA:

My daughter has type 1 diabetes and is on NPH with a sliding scale of Humalog in the morning, a sliding scale of Humalog at lunch and dinner, and NPH with a sliding scale of Humalog at bedtime. Her sliding scale begins with 0.5 units of Humalog if her blood sugar is at 200 mg/dl [11.1 mmol/L] and increases 0.5 units for every 25 mg/dl [1.4 mmol/L] because she is so sensitive to Humalog. We are having a very difficult time keeping her blood sugars normal in the evening. When we increase her NPH in the morning, she struggles with hypoglycemia in the morning but continues to have high blood sugars at dinner. She is a gymnast, works out four days per week, and her bedtime numbers are higher after she works out. The doctor would like to put her on a additional shot of NPH at lunch time to try to prevent the hypoglycemia but to try to bring down her numbers in the afternoon and evening. What is your opinion on this and will there be an overlapping of insulin?

Answer:

Your daughter may do better with a change in her basal insulin dosing. If she were my patient, I would probably suggest that you try some Lantus (insulin glargine) insulin instead of the NPH. Lantus provides a better basal or background insulin profile than NPH. She would also take Humalog or NovoLog then based entirely on carbohydrate intake and to correct for high blood sugars. You may wish to print this for your physician and talk about alternate strategies for fixing your daughter’s labile blood sugars.

MSB