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Question:

We have an 8 year old son who was diagnosed 3 years ago. We have always had a difficult time with regulating his blood sugars. We recently had thought that maybe we should try the insulin pump on him, however our endocrinologist would like to try a regimen of 4 injections a day of either Humalog or Regular with no long acting insulin. He currently is on 3 shots per day: Humalog and NPH in the morning, Humalog at supper and NPH at bedtime.

Can someone please explain to me how this works without the long acting insulin?

I would also like to hear from other parents, if there are any, who are already using this method. I am very confused as I have never heard of this option before. I have been under the impression that a long acting insulin is always necessary.

Concerned Mom (bbechard@eau.net)

Answer:

It is unusual to take only Humalog or regular before meals and at bedtime. Usually a "basal" insulin such as Lente, NPH, or ultralente in the evening or twice daily is necessary. You should discuss with your child's physician why he/she prefers to use a short acting insulin in the evening (I assume the 4th injection would be at bedtime).

The goal of multiple injections or the pump is to more closely mimic the way the body makes insulin when the pancreas works normally. In people without diabetes, usually the pancreas makes a relatively constant amount of insulin when the person is not eating (the basal insulin) and then makes extra when the person eats.

With multiple injection therapy usually an intermediate or long acting insulin is used at least once a day to provide the "basal" insulin requirements and a fast acting insulin (Humalog and/or regular) is given with meals (bolus insulin).

With pump therapy, the basal insulin is given as a continuous, 24 hour infusion of regular or humalog, and extra regular or humalog (bolus insulin) is given with meals.

The choice to use a pump is a very individual one. It requires a tremendous amount of commitment and responsibility which many 8 year olds cannot handle. It has been used successfully in children this young and younger.

If you want information from parents of children who have tried multiple injections and/or pump therapy, I suggest you look at the CWD Forums or join a chat session on children with DIABETES.

TGL

[Editor's comment: Also, look at the pump section at Children with DIABETES to compare notes with other people interested in insulin pumps. WWQ]

Original posting 14 Feb 97
Updated January 16, 2006

  
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