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From Norman, Oklahoma, USA:

My son is 12 years old and has been a Type 1 Diabetic for 9 years. He is controlled fairly well with Humulin Regular and NPH insulin. We were counseled by a dietitian and our new doctor about changing to Ultralente and Humalog insulin. My son has been on Ultralente with Regular insulin for about 1 month. With this change my son has had some severe low blood sugar reactions in the early mornings. At first he was doing the Ultralente every day at night before bed, but then was having consistently high blood sugars during the day and at night. Then the doctor split the dose to twice a day, and that was when the severe low blood sugar reactions happened.

Do you think we are having such problems because we are still using regular insulin and not the Humalog insulin? Our doctor did not want to make a change to both insulins at once she wanted to do it in two steps. Well, I gave up and went back to our old regimen because it worked.


I think that you did right to go back to the insulin dose that seemed to be working "fairly well;" but I also think that you need to assess with your son's doctor just how good a degree of control this really was. I have an idea that the A1c's may have been running at the upper limit of normal for the method used + >30%; i.e., 8.5% to 9.5% where the upper limit of normal is 6.4%. This is a fairly common situation and sometimes quite hard to improve on; but with the current emphasis on meticulous control in order to avoid later vascular complications, it's important to try. That I think must have been why your new doctor tried the lispro insulin [Humalog®] and Ultralente approach.

If I am right about the A1c levels, I think it would be a good idea to try to still make changes only this time to start with substituting Humalog for the usual human insulin, such as Humulin. Humalog starts to act in about ten minutes and is not effective beyond four hours. It has the great advantage that you can give it immediately after a meal and so take into account both the pre-meal blood sugar as well as appetite. On the other hand, it may not act long enough to properly cover lunch, so that you may either have to consider another dose at that time or mixing the morning Humalog with some Humulin R.

I am not quite clear why the Ultralente seemed to be unsatisfactory. Ultralente acts more slowly than NPH and has a more protracted action. It might be appropriate to try a rather higher dose in the morning and a smaller one at night, given perhaps before supper and initially checking blood sugars before the bedtime snack. There are of course other factors that may be affecting blood sugars especially exercise patterns and perhaps stress at school.

It is important to try at this stage to achieve the best possible level of control without making too big a production out of it, and if it doesn't work out just feel good that you all tried and decide to have another try before college with some form of intensive insulin therapy or even a pump.


Original posting 21 May 97


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