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Question: From Japan:
My 8 year old daughter has had Type 1 diabetes for 4 1/2 years. We check her blood sugars six times a day and she is on Regularheck her blood sugars six times a day and she is on Regular (sliding scale, 5 units for 100-200 blood glucose) and NPH (13 units) in the morning (7 A.M.), Regular before dinner (5:30 P.M., sliding scale, 1 1/2 units for 100-200BG) and NPH (4) at bedtime (8:30 P.M.) and weighs 70 lbs. Her HBA1c's are 4's-6's. Since my husband is in the military and we are stationed in Japan for the last 1 1/2 yrs., there is no specialist available. For the last week, her morning snacktime (10 A.M.) blood sugars have been very high (200-400 range). The rest of the day, including morning, are usually in a normal range (below 200). I switched bottles of insulin to new ones after the first 3 days of highs, then, after the second 3 days of highs, I increased her morning Regular and it didn't help. This morning, I also cut back her breakfast by one starch. She called from school this morning to tell me she was 417. Are there any "tricks" I should know about since going by the basic formula of increasing when high does not seem to be working? Also, Lispro insulin is not available here to try at this time.
Answer:
First of all, if your daughter is 8, you should expect in the next several years you will need to make many changes in her insulin dose and diet as she grows and develops. You will definitely need the help and advice of a pediatric endocrinologist. I suggest you speak to the head of the health service and insist that they find a way for your child to periodically see a pediatric endocrinologist, even if it means traveling to another location a few times a year. With modern technology such as E-mail, fax, and telephones, you should be able to have contact in between visits to help you change the dose. It is very important to have a physician familiar with your child's particular case to help you through these years.
If the blood sugar is going up at morning snack time and coming down by lunch, you might want to assess the kind of carbohydrates she is eating at breakfast. I find that even if one "counts carbohydrates" and properly accounts for fast acting carbohydrates like orange juice or bananas at breakfast time, Regular insulin may not work fast enough to prevent the early rise in blood sugar. Another approach to consider if you child is able to fit this into her schedule is to cut down on the breakfast, increase the mid morning snack, and try to increase the A.M. Regular.
Even if Lispro insulin is not available in Japan, if you are not able to control the early rise in blood sugar after breakfast with dietary changes, you should be able to arrange to obtain it in Japan. If you do this, make sure you always have a few extra bottles in the refrigerator in case you break one.
Original posting 19 Mar 97
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Last Updated: Sun Jan 15 12:01:30 2006
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