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July 31, 2004

Hyperglycemia and DKA, Insulin Analogs

Question from Virginia, USA:

My son was diagnosed about eight months ago. He was changed to NovoLog before meals about two months ago. Oddly, he ran high (300s mg/dl [16.7 to 16.3 mmol/L]) two to two and half hours after NovoLog and a meal, despite adjusting ratios between 20:1 down to 10:1. However, like clockwork, at three and a half hours after NovoLog, every time, his blood sugar dropped dramatically into the 40 to 60 mg/dl [2.2 to 3.8 mmol/L] range. It was as if he were having a delayed response to the NovoLog. This went on for three weeks until I asked for Humalog, which he then responded to as we would expect, blood sugars in mid 100s mg/dl [around 8.0 mmol/L] two hours after a meal. I had the impression that NovoLog and Humalog were very similar. Do you think we may have just gotten a bad bottle of NovoLog? Or, do you think there is some physiological reason for this reaction?

Answer:

NovoLog and Humalog are rather similar, but occasionally one individual has a unique response. It sounds like there may have been some binding to the NovoLog that slowed it down either under the skin or in the blood itself. If you have changed to Humalog and it is working as you want it to work then there is nothing else that you need to do. If you want to experiment and see if there was something odd about that particular bottle of NovoLog, which is unlikely, then try it again and see if the same thing happens again. There is only a single head to head comparison of NovoLog and Humalog published in the clinical diabetes literature to my knowledge to date and both acted similarly in this small study.

SB