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Question:

From Mississauga, Ontario, Canada:

Any idea why the doctor has my eight-year-old daughter on a Humalog-Regular-NPH-Lantus regimen? Her regimen is: around 7:30 a.m. - Humalog on a 1:15 ratio, two units of Regular and three units of NPH; and dinner (roughly 5:30 p.m. or 6 p.m.) - calculate the Humalog using the 1:15 ratio then subtract one unit and also give one unit of Regular since her NPH is still working, but give the entire amount of Humalog if she's high. The Regular covers her 8 p.m. snack. Around 10:30 p.m., give her nine units of Lantus and check her blood sugar. If she's higher than 11 mmol/L [198 mg/dl], also give her one unit of Regular.

Answer:

The best person to answer your question is your daughter's pediatric endocrinologist. The implication that you are not asking suggests there is an issue of sorts. The "easy out" answer to your question is that, presumably, based on your daughter's glucose patterns from her testing, is that the doctor is trying to appropriately match up insulin to glucose levels relative to meals and activity.

There is NO single "right way" to give insulin. As I know you are aware, the different insulins available commercially have different onsets of action and different onsets of peak effect, and different durations of action. They can be mixed and matched. The morning NPH is likely given so as to avoid giving your daughter an injection at lunchtime at school. The evening regimen does seem complicated but, again based on your description, has likely been put into play to account for when she has been high relative to meals and snacks.

To me, the next question(s) you should ask yourself and your doctor includes:

  1. Is my daughter's glycemic control where we want it? If so, then perhaps the ends justify the means. But if not, then...

  2. What can we do in terms of insulin dosing, meal adjustments, or activities to aim to reach those goals?

  3. Is there excessive and/or symptomatic hypoglycemia? If not, then again, the ends likely justify the means. If so, then again, where can adjustments be made?
If you have questions, you should ask your primary diabetes team. If you have issues with the team, you should feel comfortable discussing them because no one should be a stronger advocate for your child than you. If there are other concerns and you feel that you really need a second opinion from another pediatric endocrinologist, again you should feel empowered to do so.

DS

DTQ-20080929163617
Original posting 4 Oct 2008
Posted to Insulin and Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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