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June 20, 2003

Insulin Pumps

Question from Atlanta, Georgia, USA:

Our 12 year old son, diagnosed two and a half years ago, has been on a pump for a year and a half, and I have thought about putting him back on Lantus with Humalog for the summer. I asked his doctor for advice, but my questions were only partially answered. My son currently gets 10 U of Humalog per day as basal insulin, but more than half of that is given between 10:00 PM and 3:00 AM. What advice would you give a parent contemplating a temporary switch back to Lantus with Humalog from a pump? What guidelines would you use? Can a child with basal requirements such as this be switched back to Lantus? Is there any way to manage night time highs if they occur other than Humalog correction?

Answer:

As far as a “vacation” from the insulin pump during hot and sweaty summer months, we have many people who do this. Sometimes just using the pump from dinner time through and including breakfast time may also work with short-acting insulin analogs (Humalog or NovoLog) boluses during the daytime.

If you want to just stop the pump for a few months, this would also be fine. It usually takes a week or so to relearn a Lantus basal insulin dose. As long as you do lots of monitoring, this should be accomplished. Lantus often does not last a full 24 hours, so you may want to consider a morning plus bedtime Lantus split or a bedtime Lantus dose plus a lunchtime NPH dose. All should be based upon actual blood glucose profiles and patterns with close contact with your son’s diabetes team to give you advice.

SB