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Question:

From Toronto, Ontario, Canada:

My 27 year old daughter was diagnosed with type I diabetes about 5 years ago. She has had excellent control of her blood sugar until recently. They continuously reach levels as high as 15 and average around 8.5. She takes two doses of Humulin 60/40, approximately 18 units each dosing. She weighs about 120 lbs. Her morning level are 7, lunch 7, dinner 14, and evening 9. Should she be changing insulin? Her exercise levels have not changed over time.

Answer:

I am rather hesitant to give any advice regarding your 27 year old daughter because I think it important not to interfere in her relationship with her diabetic team. With that caveat, however, I would agree that her blood sugars especially before dinner are higher than they should be: it would be important though to know how they relate to her blood A1c levels, a measure of average blood sugar over the whole 24 hours and for the previous three months or so. It might be that all she needs is a little more long acting insulin in the mornings since her total insulin is only about 0.65 Unit/kg. body wt/day.

On the other hand, and especially so if she is considering starting a family, now might be an appropriate time to consider starting on 'intensive insulin therapy.' This would involve giving regular insulin before meals, probably changing to the new substituted, shorter-acting Lispro insulin and in addition taking a long-acting insulin in the morning or the evening. If this went well she might then consider moving on to use a pump. These changes would mean working closely with an experienced diabetic team; but they would also offer the best chance of avoiding complications in the years to come.

DO'B

Additional comments from Dr. Quick and Dr. Jones:

I am not (yet) willing to advise use of lispro during pregnancy. Lilly doesn't have any data yet, and I don't feel comfortable with advising its use in the circumstance of a young woman with diabetes who's considering pregnancy in the near future.

WWQ

I know that Lilly does not endorse the use of Lispro during pregnancy. However, I have used it in some select cases. Until additional data is available, I would only recommend its use if all other regimens have been tried and failed.

OWJ

Original posting 22 Mar 97

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