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From Finland:

My son was diagnosed eight months ago. He weighs 19 kg and gets 4-5.5 units of insulin per day. He eats small meals every two hours. Insulin take is as follows: 2 unit of Protaphane at 8:30 and 1 at 17:00. Regular (Actrapid) 1/2 8:30, 1/2 17:00 and sometimes also at 20:30 (he gets extra food then). I take it he has still insulin production left. Am I correct? HbAc1 is 6.3.

The problem is that he usually has small amount of ketones in his morning urine. We test even during the night (at 1:00 and 3:00). He doesn't get ketones when the night readings are around 8 mmol (144 mg/dl). I'm 100% sure that he doesn't go low since after lots of testing I've found his blood glucose levels pretty predictable and even then we test, test, test, just to be sure.


The test for ketones is exceedingly sensitive so that I would not be too concerned at finding trace ketones in the morning. The usual explanation for this is that there have been low blood sugars in the middle of the night; but you seem to have excluded that possibility. An alternative is that in spite of his frequent meals he is till not getting enough calories. When children first develop clinical diabetes they often have a lot of catching up to do in lean body mass. Eight months is a little long to be still doing this and he must still be making some of his own insulin; but you might interpret this idea by looking at his growth chart from birth if you have it.


Original posting 22 Dec 96


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