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Question:

From Ohio, USA:

Our daughter was diagnosed as Type 1 at three years of age. A couple of questions:

  1. The literature seems to "take it for granted" that, when split shots of NPH and R are taken, the ratio is on the order of 70/30. For our daughter, the ratio is "inverted," (i.e., approximately 30/70). We have on a couple of occasions tried to gradually "make the switch," but have found that this results in glucose levels that are high at mid-day and/or low pre-dinner. So we have adjusted the insulins accordingly, and ended up back at approximately 30/70. We also have an adult friend diagnosed 20+ years ago who shows the same phenomenon. She, and her children, are healthy.

    Our doctor is unconcerned about the relative levels, and takes the approach that "everyone is different." Do you have any feel for how common this "inverted levels" is?

  2. Our doctor advises that "too much" Nutrasweet [aspartame, an artificial sweetener] can be harmful. Can you quantify "too much"? We like to keep our daughter well hydrated, and that is easiest to do by giving her diet soda; which we now dilute 50/50 with tap water, in order to dilute the Nutrasweet.

Answer:

  1. The 70/30 [N/R] mix of NPH/Regular was originally a convenient mix for patients with Type 2 Diabetes who required supplementary insulin and who had difficulty in mixing insulins. Later it became a feature for cartridges in pen injectors. The practise for children with Type 1 Diabetes has for many years been to keep the ratio of NPH to Regular insulin flexible; but to mix the insulins just before injection in the one syringe.

    It is rather unusual to find that a 30/70 [N/R] ratio works well in a three year old, more often the problem at this age is extreme sensitivity to regular insulin. But as your doctor sensibly points out, there is a wide variation in the response to insulin between individuals and if you are maintaining fasting blood sugar levels in the 100-200 mg/dl range and getting A1c levels that are reasonably close to the upper range of normal +25% for the method used, then you should feel that you are controlling the diabetes very well indeed. It may not always stay like this so keep your mind open to a change and to the later possibilities like using a sliding scale for the amount of Regular insulin and perhaps to giving lispro insulin [Humalog® brand] as the short-acting insulin which has the advantage that it can be taken after the meal and so adjusted to blood sugar and appetite. Be sure though to work out any changes with your daughter's physician.

  2. Aspartame (Nutrasweet brand) is a dipeptide of phenylalanine and aspartic acid, both natural amino acids. When it first became available there were many groups who claimed adverse symptoms from ingestion; but over time these have not been substantiated. I don't think that your daughter will come to any harm from drinking 50% soda pop in addition to milk. One day she may even drink water; I wish my grandchildren did!

DO'B

[Editor's comment: The premixed insulins use terminology that's different in the USA compared to Europe: the ratios in the USA start with the NPH, then the Regular (i.e., 70/30 would be 70% NPH and 30% Regular). The ratios in Europe start with the Regular, then the NPH (i.e., 30/70 would be 30% Regular and 70% NPH). Both bottles contain exactly the same thing! WWQ]

Original posting 30 Jan 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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