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Question:

From Connecticut, USA:

Can our six year old daughter take one dose of insulin instead of two? She currently is taking a Regular and NPH dose in the morning and only NPH at night. Why not use a combination with a possible longer acting insulin (Ultralente)?

We have seen our local pediatric doctor and a pediatric endocrinologist at Yale and she said if we have to go to two doses later, she [my daughter] might think she's doing something wrong. That sounded like a lame excuse to me. Is there a reason for the reluctance to use a one dose a day routine if it is working. We have done this previously on our own with good control just using NPH. I feel the less we have to inject her the better.

Answer:

Yes, one shot a day will do if you don't mind inadequate control. In the past (twenty years or more ago), it was common to use a single insulin injection in Type 1 diabetes. Since blood glucose testing was one fasting test every three months at the doctor's office and glycohemoglobins weren't used, and urine sugars were used at home, lousy control was the norm. The experts even argued (in the New England Journal of Medicine editorial columns) whether blood sugar levels were related to complications at all!

Recent scientific evidence that metabolic control matters, such as the DCCT, together with the development of home sugar meters for instant feedback on blood sugar levels and glycohemoglobin testing, have revolutionized the care of people with Type 1 diabetes.

If your daughter's blood sugars and glycohemoglobin can be maintained in an adequate range on a single shot of insulin daily (which might be possible during the honeymoon phase), we see no harm in such a program.

SS
WWQ

Original posting 4 Jan 97

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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