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Question:

Our son, who has IDDM, is experiencing some very high blood glucose levels and big swings during the morning. For instance he will wake up at 7 am and be 14.1 mmol/l (253 mg/dl) then at 10 am he is 25.2 (453 mg/dl) and then at noon he is 3.6 (64.8 mg/dl). He receives 3 N and 1 R at 7, breakfast at 7:30 (always finished by 8am) snack at 10 (right after his blood glucose test) and then lunch right after his noon blood glucose. There is definitely 2 hours between breakfast and the 10 am blood glucose. For breakfast he eats a bowl of cereal (maybe Cheerios, bran flakes etc) with milk. He is being very aggressive at school (which could be partly his personality, but also suspect it is the high that is affecting his mood). By noon he is very clammy and tired and whiny--definite signs of a low.

We have a few thoughts: Try Humalog (not available here, but we could possibly have someone send it from the US), try giving his shot at 6 am and keep breakfast at 7:30, try toast and jam for breakfast (although all cereals he has show between 29 and 31 g carb for 30g cereal with milk). We are very concerned about the high and don't like the swing he does. Other days of readings are : 12.7, 22.1, 2.9 or 17.2, 21.9, 3.4. We even tried giving his evening N at 11 pm, but that just made him higher for the am blood glucose and never appeared to kick in. HELP! Our team in Toronto keeps insisting not to worry about it, but we can't. We tried No RE, less N, more N, more RE....what else could there be? Thank you very much.

Most of the times the low noon blood glucose are on school days. They play outdoors from 11 til noon. She can't change the playing to earlier as it is not convenient for her (fair enough). WE have tried to compensate for this by adding extra carbs to his mid morning snack--now he is getting a small banana, 1/2 fruit yogurt, crackers, cheese and cucumber. The guy can't eat much more.

Answer:

It certainly sounds as if your child might do better with lispro insulin [Humalog® brand] as it should start working faster than the R. I suspect however, your child might need less than 1 unit of Humalog before breakfast to avoid the low at lunchtime and Humalog still is not approved to use with diluent to facilitate drawing up small doses.

Other possibilities to consider:

  • Would your child consider a diet yogurt or even NiteBite Snack Bar for breakfast? A breakfast lower in fast acting carbohydrates and higher in protein (or uncooked cornstarch) may blunt the rise in blood sugar after breakfast and last longer into the morning.

  • I would skip the cucumber at snack unless he loves it or he needs it to put the yogurt or cheese on. Seems to me, if he needs that much food you might want to consider food higher in carbohydrate and protein concentration so the amount isn't overwhelming. A NiteBite and some milk might be a good snack.

  • Another thing to consider might be trying Ultralente instead of NPH before supper.

You should not make any changes without consulting first with your child's own physician. Only trial and error will tell you what works best (and soon your child will grow or have a different schedule and you will have to readjust his insulin and food again!).

TGL

Original posting 2 Feb 97

                 
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Last Updated: Tuesday April 06, 2010 15:08:54
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