Hi new here...questions about lantas

[Lizzy731]

My 2 1/2 year old daughter was diagnosed about 7 weeks ago and is currently on 2 shots a day with humolog & NPH. I have found that it has not been that effective in controlling her sugars. I have read about lantas and humalog therapy and I think that I am going to switch her at the next team meeting. My concern is all those shots per day. I am assuming that she will have to have at least 4 because the lantas can't be mixed. From what I have read, humalog is injected prior to each meal (it covers snacks as long as they are low carb < 15?). Do the snacks have to be 2 hours after a meal? Lantas & humalog is injected in the moring prior to breakfast. Is the humalog on a sliding scale according to the finger stick result and how many carbs she will be eating?

I don't think I am ready to put her on the pump yet because she will be attending a private preschool in September with no school nurse and I don't want them touching the pump for hwer snacks. When she is 4 and in the public school system...I will definitely push for it.

When your children were diagnosed, what was the treatment plan like and how fluctuating were their sugars? It's so frustrating because my daugher is a slow/picky eater and to stand over her and make her finish her meals is so wrong...I don't like the message that I am sending her, but I am afraid of her getting too low if she doesn't eat enough. She is also an anxious kid and everything sets her off and her sugar skyrockets.

I am happy to find this forum, I'm sure that I can find some great advice from all of the more experienced parents!

[rhianna]

HI ,

First up , it gets easier , My daughter is 3, and were in our 8th month now. From the start we have used Lantus , and mixed it with Novarapid ( you call that something different) so its 1 injection,in the mornings now, ( it use to be before dinner, but she was having to many lows at night) . Cassie's program has changed quiet a bit, her insulin dropped off dramatically and has only just started to pick back up , ( the honeymoon period) . When she was first diagnosed I use to literally force feed her also , we ended up ringing our educators and getting the dose reduced, don't wait till your next meeting , phone them. If she's a picky eater, I would consider going on the pump early, Cassie is a good eater ,(we start pumping in 2 weeks), but we were diagnosed there was also a little boy ( 2yr) who was a picky eater and they went onto the pump straight away as they couldn't get him to eat the right amount at the right times.
Funny Cassie just about to start preschool and I'm more worried about them giving her injections:) :) .

BTW , if you can get some sleep during the day ;)

Rhianna

[twicker1]

I know you are only 7 weeks into this, and looking for the best treatment available. I remember reading about Lantus and I questioned Brandon's doctor about it at his first checkup and the doctor pretty much shot me down. I was furious because the NPH didn't seem to be working, but what you have to remember is that during the honeymoon stage, which could last up to two years in extreme cases, their blood sugars are going to be all over the place. I know it seems that you are always chasing blood sugars, but I think going on Lantus and Humalog (or Novolog) this early in the game will really throw you for a loop.

At 9 months into his diagnosis, his doctor DID put him on Lantus and Novolog, but I took him off of it two weeks later. He was still so sensitive to the Novolog that if his BG was 300 and I gave him 1/2 unit of Novolog he would plummet down into the 40's. Now, 5 months after that we tried it again and it worked wonderfully.

Yes NPH sucks, but in a way it kinda lets the insulin work by itself until the honeymoon is over and the parents are truly ready to take on all the carb counting. The other reason I've heard doctor's favor it in the beginning IS because of the multiple shots you were talking about. It takes most children a couple of months or longer to adjust to diabetes and the less shots per day they have to take, the better.

[Amy C.]

To counter the previous post, for children who are sensitive, it is possible to dilute Humalog to give the correct amounts. You can go down to 1:10 to precisely give the correct dose.

Although some folks can live with NPH and do well, it did not work for my 3 year old child. His A1c during those years was almost always close to 9. He had wild fluctuations in blood sugars levels that were difficult to control. Most of all I hated the rigidity of the eating schedule -- set snacks and set mealtimes didn't always work.

The pump is the best option, but you have objections to the day care pressing the buttons. Pressing the buttons on a pump is much easier than giving an injection at lunch, which is what you are looking at with Lantus/Humalog. Would you allow the day care to give your daughter a shot?
If not, and if you don't want your daughter on a pump, staying on NPH is the best option for your situation right now.

You need to determine how to best time the food with the insulin.

Snacks on Lantus are sometimes not necessary. With Philip he ended up needing only the afternoon snack.

The pump is the best way to go with a picky eater. You may want to reconsider if the day care can give a bolus or not.

[jeep_bluetj]

The basic therapy is essentialy the same with both pumping and MDI (basal/bolus using Lantus or Levimir as a basal with novolog/humalog as a fast acting).

The difference is convience with delivery method, and variable basal settings. Pumping really wins on those two counts.

MDI is great for a picky eater too - Just bolus after the meals.

We used lantus for 4 years - it worked great for us. We switched to pumping primarily because we were wearing out the sites. The extra injections were not a problem. The added flexibility far outweighed the extra shots.

NPH is not very predicable for most people. NPH tends to have serious lows more often. Sick day management on a 2-shot per day plan is very difficult. I'd definitely recommend talking to your endo about some sort of basal/bolus plan.

AND: most folks don't realize it, but "when BG stabalize" never really happens. T1 BGs are ALWAYS up and down. There may be a few good days, then some random 350 pops up. (or a 50, or a day without insulin, or whatever). It's NEVER _stable_. It's just you learn how to predict and react. It'll take time.
BG isn't a report card, it's information you use in treatment.

[EmmasMom]

Hi and welcome to the forums!

My daughter is 2 1/2 and has been on a pump for 17 months now. It provides amazing flexibility with eating, and has made life so much easier for us!
I know it's a big commitment and it seems like a lot to learn, but it's actually much easier for most caregivers than giving injections, just push a few buttons, (based on what the child actually wanted and ate) and you're done!

MDI w/ Lantus & Humalog is the next best thing to the pump, and it will provide a lot more flexibility than NPH, but the extra injections and constant dosing calculations can be tiresome. It works well for many people, but for us it was a lot more work and trouble than pumping is, (Emma was very young at the time).
With the pump I can give tiny doses of insulin anytime night and day with no pokes! I can correct a slightly elevated blood sugar, cover 1 cracker or a bowl of ice cream with the push of a button, and the pump remembers all the important calculations for me. I love it!!! :D

Good luck with your decision!

[Lizzy731]

Thanks for all the great advice. I think she may be out of the honeymoon period because her evening NPH has had to be increased during the past few days and I still think it needs an increase (although she has gained 4 pounds since dx...maybe this is reason for highs at night?). She started her honeymoon period about 2 weeks after dx. Her evening dose NPH was lowered but not her day dose...it was strange.

Anyway...when I spoke to the preschool teacher, she sounded a bit hesistant until I reassured her that she would not be administering any insulin shots (I don't even trust my R.N. mother to do it because the dose is so small and you need very good vision to draw it up). I don't know how she would react to doing anything with the pump. Btw, on lantas therapy...do you have to give an injection for snacks? She would be having a snack at 11 AM in school and she eats breakfast at 8 AM. She will only be attending school twice a week for 2 hours a day. Would a low carb snack (15 grams or less) need a humalog shot? In her current therapy, her humalog covers her breakfast and AM snack, I was wondering if this is the same with the lantas therapy and MDI.

Btw, is anyone on CGM at a young age?

Thanks to everyone for your responses. It's so nice to find a place where I can vent and get advice. No one I know has children with type 1.

[rhianna]

Hi,

Cassie always has morning & Afternoon tea, although now we've moved Lantus to mornings she doesn't have supper, Cassie is 3yr 1month.
She has lantus with novarapid bf b'fast, actrapid bf lunch , and novarapid at night , 3 injections generally, if we need to do a correction its normally at midnight and she has novarapid.

I'm in Australia so this will be different , but we've never injected for snacks , and we've always had to give her her m/a tea's. Cassie eating is very rigid, she has 30gr carbs at b'fast , 30 gram carbs at lunch , and 15- 20gr carbs at dinner, her snacks are always 1exchange 15 gr carbs. BTW Cassie is a great eater , but gained a fair amount of weight just after she was diagnosed. I was told this is normal as normally they'll have lost a bit before diagnosis and the weight will settle down. which until recently it had, but thats one of the many reasons were moving to pump.

HOW ARE YOU ??

BTW I'm currently emailing my educators Cassie's BGL's as I'm not that happy , we are always in touch with our educators (team) and never just wait for our appointments.

Rhianna

[caspi]

Cameron has Humalog with each meal and Lantus at night. He gets two snacks a day - one 15 carb snack in the afternoon and one 30 carb snack in the evening. The snacks are always after the two hour post meal bg check. This isn't to say he doesn't eat at other times -- when he's hungry he can always have a "free carb" food.

As far as sugars fluctuating, they will ALWAYS fluctuate. You may have a good few weeks here or there, but then something always seems to come up that will throw them way off (growth spurt, illness, etc.) That's what is so frustrating about this disease!

[Amy C.]

Btw, on lantas therapy...do you have to give an injection for snacks? She would be having a snack at 11 AM in school and she eats breakfast at 8 AM. She will only be attending school twice a week for 2 hours a day. Would a low carb snack (15 grams or less) need a humalog shot? [/B] In her current therapy, her humalog covers her breakfast and AM snack, I was wondering if this is the same with the lantas therapy and MDI.


2 hours a day is hardly long enough to worry about doing a shot at the school. It seems like she is being picked up shortly after her snack and she could have the shot then, if necessary. Otherwise, I would include what she ate at snack for her lunch. It seems like her lunch would be around 12.

Each child is different on Lantus. Some endos start kids on 3 snacks with the three meals, but only shots at the meals. It is possible your daughter would need the small snack without insulin. You can't predict this.

[Abby-Dabby-Doo]

Lizzy-
Everyone does a little something different, so your daughter's way will be what works for her. That's why you'll find so many different answers from us.
My daughter who is kindergarten is on Lantus/Novolog. She receives her Lantus in the morning. She receives Novolog to cover her meals, and her snacks are 14 carbs or less to receive no insulin. Her insulin has to be given 3 hours apart. So if she ate breakfast and received her insulin at 9am, she wouldn't be able to eat lunch and receive insulin until 12pm.
You'll find out what works for you!
Glad you found us here~

[Mama Belle]

Here's another regimen to consider, it has worked relatively well for us for five years.

Lantus dose in the evening (or morning if you decide that works better). Humalog with dinner, Humalog and NPH in the morning. The Humalog covers breakfast and the NPH covers lunch. If you see too much peak variablility with the NPH, then you could always cut the NPH in the morning shot and switch to giving a shot at lunch.

[lynn]

Hello and welcome. I'm glad you found this site. We all learn so much from each other.
My son was 2 1/2 at diagnosis. We started on Humalog and NPH. Thankfully it was just for a few weeks until we could go through the education process and learn what was necessary to change to MDI. I found it very hard to get him to eat exactly what he needed to when he needed to. We were either really high or really low it seemed. And I couldn't stand feeling like I was cramming food down him! That just seemed so unhealthy and wrong!
He took Humalog and Levemir until Monday, when we started on the pump. I'm glad we waited to start pumping. It helped me get a better grasp on how things work by having to calculate myself.
I know that many people can get away with giving snacks which are less than 15 carbs and see no real spike in bg, but Nathan ALWAYS went up if we got over three or four carbs. I think maybe the tiny bodies just can't take it. Some of his meals last year weren't over 15 carbs.
My husband and I were really worried about the extra shots at first. He did well with his two a day, but he didn't like it. We worried that he would really begin to fight with so many. He didn't though. I honestly think the reduction in stress from the constant need to push carbs on him made up for it.
I would encourage you to make the change. The pumps will be there for you when you are ready too.
This does get easier.
Lynn

[coconne3]

Hi, My 3 yo (diagnosed in January) recently switched to humalog for meals/snacks and lantus each evening. We were to the point of tears trying to get her to eat the regimented amount of carbs each meal/snacks when sometimes she just wasnt hungry. Now if she wants to eat she does and we give humalog and if she doesn't we wait....
It has made a world of difference, yes there are days she gets more injections but the stress/headaches are less (at least for me). We also didn't want to have to teach school how to give/calculate insulin so on the days she goes to preschool, we go back to nph/humalog and the rest of the week she doesn't get nph. The days of fighting are less and the days she has to get nph are not as much of a hassle anymore. Hope this helps.

[Fairlight]

AND: most folks don't realize it, but "when BG stabalize" never really happens. T1 BGs are ALWAYS up and down. There may be a few good days, then some random 350 pops up. (or a 50, or a day without insulin, or whatever). It's NEVER _stable_. It's just you learn how to predict and react. It'll take time.
BG isn't a report card, it's information you use in treatment.


This is so true. Thank you for including this in your post.