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August 21, 2003

Daily Care, Insulin Analogs

Question from Ceres, California, USA:

After several months of my son's NPH peaking mid-day resulting in low blood sugars, so three weeks ago, we agreed to change to Lantus in the evening with Humalog at each meal, and this new regimen seems to keep his numbers more in range. We have continued the regimen of three snacks (15 grams of carb) per a day between meals. Being new to Lantus and knowing that Humalog is gone after three hours, are the snacks considered as crucial as they were when using NPH? What other items should we consider now that my son is taking Lantus? What is the average time frame to seeing the advantages of using Lantus?

Answer:

You will have to experiment on the new regimen to see if the snacks are necessary and whether or not Humalog coverage is needed. Getting some blood glucose readings before and after meals and also before and after snacks will answer this question as you play detective for a week or so.

Usually, it takes about three to four weeks for most patients and families to figure out the differences with Lantus compared to other insulin programs. Many children need a small dose of Lantus in the morning with a larger dose of Lantus at late evening since the Lantus does not always last a full 24 hours. Some do better with a single morning injection of Lantus rather than a single bedtime injection. Again, all dogma should be avoided and decisions made individually based upon lots of blood glucose readings and identification of patterns. Stay in close contact with your son’s diabetes team to help figure all this out.

SB