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Question:

From Newfoundland, Canada:

Our doctors would like our children, ages 3 and 6 (diagnosed since they were 2 and 3 years of age), to start on Humalog. They said that this would give them a new way of life, they would be able to eat what ever they wanted within reason (hot fudge sundaes at McDonald's). They would not be on a diet anymore, you just have to count carbohydrates and give the Humalog according to carbs counted. This doesn't sound correct to us.

We would like to try this new insulin but use when their sugars are quite high and to use it with the Humulin R and and Humulin N. Can you give Humalog with the other insulin at the same time? I know that normally you give the Humulin insulin N and R about 15 to 30 minutes before a meal; Humalog you would give after a meal. How can you successfully give them all at the same time? Our oldest daughter is a picky eater and doesn't always eat all her meals (real battle) But our youngest daughter loves to eat all the time.

Any information on these matters would be appreciated.

Answer:

I have also heard professionals claim that you can count carbohydrates and match the amount eaten exactly with lispro insulin (Humalog® brand), using a formula which each individual determines for himself to determine how many carbohydrates match each unit of Humalog. This is usually recommended for pump users who give their "basal" insulin (Insulin required to keep the blood sugar normal when you are not eating) with a continuous infusion of regular or humalog and give extra "boluses" of regular or humalog to match the amount of food eaten.

I personally have no experience with pump therapy in children, so I cannot personally comment on the success of this therapy. In general, however, I do not find that you can completely ignore the kind of carbohydrate eaten (fast or slow acting) or the amount of protein and fat eaten when matching insulin to food. In the DCCT study (which only used regular insulin with pump therapy or multiple dose therapy), although they used carbohydrate counting to give people more day to day flexibility in the amount of food eaten, they did find that the more consistent individuals were from day to day in the timing and amount of carbohydrate eaten, the better the control obtained. They did not evaluate Humalog.

When mixing Humalog with longer acting insulins, you have less flexibility than with the pump, so that it will be harder to have complete freedom from day to day in varying the amount and kind of carbohydrates eaten and trying to match carbohydrates with Humalog. (This doesn't mean that you can't have some flexibility).

Humalog has been officially approved to be mixed with Lente, Ultralente, and NPH insulins. It has not officially been approved yet to either be mixed with Regular insulin and/or the special diluents provided to make up diluted insulin. Although not officially approved yet by Eli Lilly, there are abstracts published evaluating mixing Regular and Humalog, and many people find this a useful combination. I have had patients mix Humalog with combinations of Regular, and/or Lente, Ultralente, or NPH in the same syringe with no problems.

I am not yet aware of any studies published using diluted Humalog, so as of yet I have been hesitant to recommend this until I get more information from Eli Lilly that there are no problems.

Humalog ideally is given before food to prevent an increase in blood sugar, but since it works so quickly, may work quite well when given after eating if you are trying to determine the dose of insulin according to what your child ate. It shouldn't make much difference if Lente, Ultralente, or NPH is given after the meal as these insulins won't start to work significantly for a few hours anyway. If you are mixing Humalog and Regular, it probably won't make much difference if they are both given after the meal. Regular alone without Humalog given after the meal may not start to work fast enough to cover the meal.

There are many ways to use Humalog. It can be given before food to prevent a high blood sugar, or it can be given "retroactively," to chase down a high blood sugar. You should work with your child's own physician to decide if, when, and how this new product may help control your childrens' blood sugars.

TGL

Original posting 11 Feb 97

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