From Toms River, New Jersey, USA:
My 17 year old son currently takes 21 units of Lantus at bedtime and injections of approximately 1 unit per 20 grams of carbohydrates for everything he eats. He is very compliant and never eats without a bolus injection. He has been told that he should wait at least two and a half to three hours between meals and has always followed this advice.
Last night, he was out with his friends and ate out. Then, a short time later, they after stopped for ice cream. He did not have any ice cream because it was within an hour of eating. I recently read about the "unused insulin principle" and, although I know he should not make a habit of this, on occasion, can one who takes injections, eat within a short time of the last injection? If so, what advice can you give about the insulin ratio for the second shot?
I know a pump would allow for this type of flexibility, but he is very adamant about not wanting a pump and has excellent A1cs and, as mentioned, very compliant. I am trying to find other opinions on the timing of injections and food.
I am also curious about your opinion on bedtime snacks with Lantus. His endocrinologist says he should always eat before bed and takes a 1 to 40 ratio with his bedtime snack but sometimes he is not hungry and, if his number is above, 140 mg/dl [7.8 mmol/L], he does not snack and seems to be fine the next day. Any thoughts on this as well?
I think we must realize that we cannot specifically and exactly mimic, with insulin injections or infusions by pump, the mechanism of mother nature: all we do is approximate as best we can. Therefore, I think we must appreciate the forest from the trees: if your son is generally very well controlled as you say, and boluses with meals as directed, then the occasional lapse can certainly be understood and tolerated. But you're right: you don't want this to become to commonplace.
Personally, I find that with the use of Lantus, bedtime snacking might be able to be overlooked, but this is certainly something you and your near young adult son need to discuss with your diabetologist.
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