Question:
From Australia:
We have a five year old daughter who was diagnosed recently with Type
1 diabetes. We have been told to give the snack approximately half an
hour after the Actrapid [Regular]. We are wondering, when her blood glucose is
too high (the other day her level was 23mm/l [414 mg/dl] at 3.00pm), why she could not
forego the snack, as she doesn't feel like eating when she is high, and then
eat as usual at the next meal? This would allow time for her blood glucose
to return to a more acceptable level.
Answer:
This question was referred to several members of the Diabetes Team,
who have each given an answer:
Answer from Dr. Lebinger:
Although it makes sense to skip food when the blood sugar is high to
try and bring it down faster, I find that often it makes it harder to
figure out how to change the insulin to prevent the high blood
sugars.
As your child grows, she will need more insulin and you will see high
blood sugars when you need to change the dose. I find it helpful to
see what the blood sugars are before and after the high blood sugar on
the usual food and exercise schedule to help me better figure out how
to adjust the insulin.
If your child is sick or spilling ketones with a high blood sugar, you
should contact her doctor as she may need extra insulin right away and
can't wait until the next day to adjust the dose.
TGL
Answer from Dr. Robertson:
I'm not quite sure that I understand your question - why are you giving
Actrapid [Regular] at 2.30 pm? The principle of giving food after
insulin is that the food is to work with that dose of insulin rather than the
insulin being
given to bring down the previous blood sugar. Another way of putting
this is that without further food the blood sugar would fall rapidly making a
hypo quite likely after the previous high.
If you regularly find that your daughter has high blood sugars
mid afternoon then you should discuss a change in her usual morning
insulin dose with her team to try and prevent the high blood sugars at
2:30 PM.
KJR
Original posting 13 Oct 96