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Question:

From Misawa AFB, Japan:

My 4-year old daughter diagnosed 4 months ago with Type 1, often has high sugar levels at dinner (300+). Her afternoon snack is light and 3 hours prior. Her lunchtime sugars are low so I don't want to increase the morning NPH. On these occasions, she receives 1/2 unit of Regular along with her NPH before dinner. (She receives 7 units NPH at 6 A.M., 2 units NPH at 6 P.M.; she weighs 18 Kg). She finishes dinner at 7 P.M., and is in bed by 8 P.M., so no bedtime snack. If she has received Regular insulin at dinner, I check her while she's sleeping at 9:30 PM and she's usually dropped to the low 60's. What can I do at this point? I can't get her to really eat or drink anything. Would putting some frosting in her mouth raise her sugar enough to sustain her?

Answer:

In general we don't offer specific dosage advice which should be obtained from your diabetes team. However, a couple of observations: your daughter's pre breakfast insulin is very early (6 A.M.) and I wonder if you would have better control at lunchtime and before dinner if the NPH was given a bit later (e.g., 8 A.M.) but perhaps this wouldn't fit with your schedule. Have you tried reducing the morning NPH because the lunchtime lows may reflect that the dose is a little high. Your response to these lows (extra carbohydrate) may be part of the reason for the highs before dinner.

KJR

Original posting 23 Oct 97

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