From Colorado Springs, Colorado, USA:
We cannot get our 7 year old daughter's midmorning glucose down past about 220. We have been struggling with this for about 8 weeks. We have increased her A.M. Humalog considerably, but still get high 2 hour postprandial [after eating] values in the mid-morning. She has been in a definite growth spurt as she has grown 1.1 inches in the past 3 months. We are thinking that growth hormone is playing a key role in this problem. Should we just continue increasing the Humalog in the A.M., or not worry about these high values and believe her control will again be okay when this growth spurt is over?
Even as young as 7 years old, we are all trying to walk this tightrope between hypoglycemia and less than optimal control. First of all I should consider what your daughter's A1c is and if it is within 15% of the upper limit of what is normal for the laboratory used, I would not worry too much about a midmorning level of 220 mg/dl though. Of course I would like to know more about what time breakfast is and when the morning insulin is given and how much, what before breakfast readings are and if there is a mid morning snack and at what time. On an average, a rapidly growing 7 year old would need about 0.9 Units/kg. of body weight/day total of which two thirds would normally be given in the morning. The ratio of short to long acting insulin would again normally be between 1:3 to 1:5; this is to give you some idea of where you stand in the lispro insulin [Humalog®] dose. One possibility that you should discuss with your diabetes team is that the morning short-acting insulin is no longer active for the latter part of the period between breakfast and lunch. This might be circumvented by mixing Humalog with Regular at breakfast time. This can be done in the same syringe with the long-acting insulin; but you would have to try out various ratios.
When school is over and there is more opportunity for exercise in the morning, I think that the problem will be solved.
Original posting 6 Apr 97
Last Updated: Tuesday April 06, 2010 15:08:52
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