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April 1, 2005

Blood Tests and Insulin Injections, Insulin

Question from Monongahela, Pennsylvania, USA:

My son has been having constant high readings in the morning, 200 to 300 mg/dl [11.1 to 6.7 mmol/L]. His doctor wants to try him on Lantus. My son does not want to do the lunchtime shots. He now takes NPH in the morning with NovoLog, NovoLog and NPH at bed and NovoLog at dinner. He also takes Glucophage pills at lunch and dinner. Is there any other type of insulin that we can try without adding a lunchtime shot?

Answer:

There are other combinations of insulin, which can include Lantus, that will not necessarily require taking injections at lunch. But, I would first have you analyze what the hurdle at lunch is: Inconvenience? “Embarrassment” of having diabetes? Something else? You might want to get to that root.

One has to ask whether you are maximizing on the bedtime NPH as that in of itself might lower fasting morning readings. Lente insulin does seem to peak a little later than NPH and that would be a consideration also.

If you do switch to Lantus at bedtime (could also give this basal insulin in morning, but it is not typically my first choice), then you could still give NPH and Regular in the morning to try to “cover” for the mid-day and thus try to avoid a lunchtime shot.

The typical use of Lantus is that of a background, basal, always present insulin. It would be used with a short- or rapid-acting insulin typically which would then be taken with meals. But, there are ways around that. This basal-bolus plan really depends that you count carbohydrates well and are willing to dose insulin with (each) meal/snack intake.

If you are good carbohydrate counters, an insulin pump could be a consideration: he would not have to “take a shot” at lunch, but he (or adult at school) would have to press the buttons properly on the pump to give a dose of insulin through the catheter tubing.

DS