I am afraid that your information is reversed. When glargine and detemir became available, it quickly became apparent that these longer acting insulins produced improved overall glucose control and at the same time LESS nocturnal hypoglycemia since they had less nocturnal peak effects.  So in well resourced parts of the world, these became the standard. That is what the ISPAD and other guidelines state unequivocably.  Years ago, the "basal" insulin was either NPH, lente or ultralente with lente and ultralente mostly phased out but NPH sometimes still used where costs are a main factor.  Premixd insulin s are rather dangerous, in my view, because they cannot be adjusted for variable activity or carbohydrate intake without automatically adjusting both types of insulins instead of the preferred adjustments to only the fast acting component.    

Highly recommend book by Dr Richard Bernstein and YouTube videos by Dr Troy Stapleton (both are Type 1 Diabetics), to be convinced that Type I Diabetes can be far better managed with a Low Carbohydrate lifestyle. Type 2 Diabetics using insulin typically stop taking insulin within days when blood sugar normalise on a Low Carb diet.

Management of type 1 diabetes mellitus in children and adolescents

Authors

Lynne L Levitsky, MD

Madhusmita Misra, MD, MPH

INTRODUCTION

Type 1 diabetes mellitus, one of the most common chronic diseases in childhood, is caused by insulin deficiency resulting from the destruction of insulin-producing pancreatic beta cells. (See "Pathogenesis of type 1 diabetes mellitus".)

There are unique challenges in caring for children and adolescents with diabetes that differentiate pediatric from adult care. These include the obvious differences in the size of the patients, developmental issues such as the unpredictability of a toddler's dietary intake and activity level and inability to communicate symptoms of hypoglycemia, and medical issues such as the increased risk of hypoglycemia and diabetic ketoacidosis (DKA). Because of these considerations, the management of a child with type 1 diabetes must take into account the age and developmental maturity of the child.

Although most children with type 1 diabetes present with the classic signs and symptoms of hyperglycemia without accompanying acidosis, approximately 30 percent of children in the United States present with DKA [1,2]. The management of these patients is discussed in detail separately. (See "Treatment and complications of diabetic ketoacidosis in children".)

The management of the child or adolescent with type 1 diabetes, who either did not present with ketoacidosis or who has recovered from ketoacidosis, will be reviewed here. The term parent will be used throughout the discussion, with recognition that the primary caregiver may not be a parent.

http://www.uptodate.com/contents/management-of-type-1-diabetes-mellitus-in-children-and-adolescents

Dear Prof Dr Brink

Thank you so much for your kind interest to help me understanding "the proper insulin administration in type 1 DM"

Would you mind to discuss with me important points in your great reply to help me please:

"

1- Years ago, the "basal" insulin was either NPH, lente or ultralente with lente and ultralente mostly phased out but NPH sometimes still used where costs are a main factor.  

sahar: glargine is classified , up to my knowledge , as lente or ultralente insulin covering 24 hours, so in a child or an infant , there is a possibility to do too much physical activity with minimal diet or carbohydrate intake esp in developing countries, at this case, would this child if he is controlled by glargine long acting insulin for 24 hours, would he drop in hypoglycemic attack as most of them did not know the signs of hypoglycemia as tremors or coldness or sweating etc.. so no rapid sugar or candy intake . This was the reason that endocrinologists in the last years of the 20th century would not like to prescribe lente insulin to a child or infant with type 1 DM.

2- "Premixd insulin s are rather dangerous, in my view, because they cannot be adjusted for variable activity or carbohydrate intake without automatically adjusting both types of insulins instead of the preferred adjustments to only the fast acting component." --> sahar: still the same question how would the long acting insulin would automatically control blood sugar of a child while the mixture : regular insulin: prevents the increase in post-prandial blood glucose and NPH: maintain the blood glucose till the next evening dose according the past regimen of mixtrad (2/3 in morning then 1/3 in evening before diet which is already controlled by percentage of carbohydrate, fat and protein, fibers + good education of diabetic child 

3- I would like to know please that the prescription of a type 1 DM of a child or infant is NOW" glargine as basal insulin at night + insulin lispro Sc injection before each meal ???? is it right or what is the exact type of insulin and time of administration NOW for type 1 DM in children and infant to be obvious to me?????

Many many thanks for your precious time and your kind help

Dear Dr Prem and Dr Aldallal

Thanks a lot for your kind interest to help me understanding more the new guidelines in treatment of type 1 DM in CHILDREN AND INFANTS,

However, i need the exact prescription of glargine and insulin lispro for management of type 1 DM in this specific category??????

Thanks a lot for your valuable time

Dear Sahar,

The "exact" prescription of drugs is totally dependant on the exact amount of carbohydrate the child ingests. The lower the intake of carbs the easier it is to mange the highs and lows, a fact only now becoming understood by Doctors reading up on the subject. Hence do read up on Low Carb management of Diabetes.

Dear Dr Prim

Thanks a lot for your kind guidance. However,still my question that rises from pharmacology and therapeutics textbook,"IF A CHILD OR INFANT OF TYPE 1 DM AND REGULAR BLOOD GLUCOSE EITHER FASTING OR RANDOM NECESSITATE "TIGHT CONTROL BY INSULIN,IS IT "OUT OF DANGER OR HARM TO THIS CHILD OR INFANT"INFANT"TO BE ON LONG ACTING INSULIN GLARGINE AS BASAL INSULIN "IN ADDITION TO MDI OF ULTRASHORT INSULIN BECOME EACH DIET ACCORDING TO BGL"????????CONSIDERING THAT DIET IS EITHER ADJUSTED ON LOW CARBON OR DEFICIENT IN POOR COUNTRIES?????WOULD GLARGINE PRECIPATES HYPOGLYCEMIA ESP THIS AGE IS NOT WELL EDUCATED LIKE ADULTS TO DEAL AS PATIENT-PATIENT-DIABETES FRIENDSHIP SO CAN AVOID ANY RISK OF HYPOGLYCAEMIA WITH LONG ACTING INSULIN USE??????

I found on youtube on the site diabetes made easier "What Is Diabetes Basal-Bolus Insulin?" --> so, basal insulin is to cover the 24 hours need of the body from insulin without any need to take meals while bolus insulin is to be taken or administered before each meal according to the calculated carbohydrate content of the diet  and the patient's blood glucose level --> this is to tightly control blood glucose level. Thanks a lot

Abstract

Several guidelines have been set by the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD); however, there are no specific guidelines for our region. The following are the clinical management guidelines that were developed and are endorsed by the Saudi Society of Endocrinology and Metabolism (SSEM) for assisting patients and providers in choosing appropriate health care plans. While these guidelines are useful aids that help providers to determine appropriate practices for children with diabetes, they are not meant to replace the clinical judgment of the individual provider or to establish a standard of care. This article covers several insulin therapy regimens in children with diabetes in Saudi Arabia, including the management of acute complications, sick day management and follow-ups.

Article Clinical guidelines for the management of type 1 diabetes in...

 Dr Aldallal, thanks a lot for uploading the valuable attached article that determine in an obvious way: the new insulin analogs ( instead of regular and NPH), the dose adjustment to every child "individualization" according to blood glucose level, continuous follow-up of every child " every child" --> VERY IMPORTANT. Also management  of diabetic comas and diet control. You reported also that NO replacement to the clinical judgment of the health provider and there are standards for care of type 1 DM in children of our countries. OKAY, thanks a lot for your kind care and your generous scientific help