Today's parents have enough insulin choices to create, along with their medical team, a tailor-made insulin care program for their child. But this increase in the number of brands and types was no overnight phenomenon; it was a gradual development that took several years.

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The first insulin offered to the public was similar to “regular” insulin today. It was short acting—from six to eight hours—and most patients took two or more shots daily and limited calories and carbs to help keep blood sugars down. Then, in 1946 in Denmark, Novo Nordisk debuted NPH insulin, the first long-acting or “cloudy” insulin. NPH, still used in some patients today, works for up to eighteen hours and peaks a number of times during the day. Until quite recently, most Type 1 patients existed on a combination of regular (clear) and NPH (cloudy), taking NPH two times a day and regular insulin two to three times daily and working to create a meal plan that met the many “peaks” in insulin that came with the combination of the two.

A third, even longer-acting insulin usually called Ultralente was put on the market next. The creation of this insulin led NPH to be known as intermediate-acting insulin since the others were longer acting. Ultralente lasts even longer than NPH. Some patients found that using Ultralente and regular insulin, or even all three, worked well over a period lasting twenty-four to thirty-hours.

Until just before the twenty-first century, this remained the standard of care for Type 1 patients. With the NPH and regular regime, parents injected their child twice daily with NPH, and in the morning and at dinnertime with regular insulin. The regular insulin did not begin working until a half hour after injection time, so parents injected their children, asked them to wait a half hour, and then expected them to eat exactly the amount of food they'd been injected for. This was a challenging routine particularly for toddlers and small (and sometime rebellious) children. Parents injected their tiny ones and laid out a perfectly planned meal, only to have the tot say, “Me no hungry!” as the regular insulin was beginning to peak.

Quick-Acting Insulin to the Rescue

Needless to say, the advent of super fast-acting insulin such as Humalog and Novolog around 1999 to 2000 was a welcome change. With rapid-acting insulin choices, parents could give their children more freedom, allowing them to eat at less restricted times and to choose the amount of carbs they ate at each meal. In addition, by giving children half a shot at the beginning of a meal and then following up with the balance needed, parents could now allow their children not to finish a planned meal. To parents who had been force-feeding their little ones on regular insulin, this was miraculous.

Around the beginning of the twenty-first century, another insulin was introduced that further modernized insulin therapy. Called Lantus, or insulin glargine, it was a medical breakthrough that stayed working in the body, without peaks, for a full twenty-four hours. Parents who were not ready or interested in an insulin pump found that by using Lantus along with fast-acting insulin for meals, they could mimic a pump without using one. Unlike NPH or Ultralente, this long-acting insulin has no peaks that need to be matched with food.