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Question:

From South Dakota, USA:

My daughter, 11 years old, was diagnosed 3 months ago with Type 1 diabetes. Since then we have been able to get all of her blood sugar readings under pretty good control except for her supper readings. Most of the time they are above 200. In the morning she takes 2 units of Lispro and 19 units of NPH and in the evening she takes 2 units of Regular and 2 units of NPH. I feel so discouraged. I don't know what to do. I keep increasing her NPH in the morning but I feel like I never see any progress. Any suggestions that you could make would be most appreciated.

Answer:

Perhaps the most important thing to say is that it sounds as though you are really managing control very well indeed, so please don't be discouraged. Judging from the information provided, it would seem that her honeymoon period is over or nearly so and this removes the complication of her own islet cells responding erratically to a glucose load. At the moment the distribution of her insulin seems to be somewhat unusual, with a low ratio of short to long acting insulin in the morning (2:19) and a high ratio of total insulin between morning and evening (21:4). You should be aiming for fasting glucose levels that are between 80 and 180 mg/dl so just over 200 mg/dl is not too far out of line.

The first suggestion is to find out what before lunch blood sugars are. This may involve some liaison with her teacher and the school nurse. It could be that the rather small dose of Lispro in the morning is barely covering breakfast and has ceased to be effective by the time of school lunch. Then when she gets home she probably has a snack and that this explains the high evening blood sugars. Depending on her weight too the morning NPH may not be particularly high. Another possibility is that you are testing in the evening less than two hours after finishing a late afternoon snack so that the levels aren't "fasting." You might also try to find out if there is anything stressful academically or socially at school and also whether it might be possible to start some form of sports in the afternoon. An alternative to very slowly increasing the morning Lispro would be to try Regular instead because its longer action may better cover the lunch period. It is in fact quite common to use Regular in the morning and Lispro in the evening.

In summary, I think that you are doing fine and that your daughter has reached the stage of needing a little more insulin. I would start by increasing the morning Lispro one unit at a time every three or four days up to a total of not more than six units and by reducing the afternoon snack. If the morning blood sugars are satisfactory there is no need to change the insulin at this time as the NPH may be exerting its action over a longer period than usual.

It would be important to discuss any change in insulin dose with your daughter's diabetes doctor.

DO'B

Original posting 11 Feb 97

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