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Question:

From State College, Pennsylvania, USA:

My daughter was diagnosed as Type 1 a year ago. She just turned five this past summer. Between last year and last month, we have been controlling it with her diet (no insulin was needed). In the last month and a half, she has been ill and has been running high. However, only 1/2 to 1 unit of NPH is needed and not every day. We are having a hard time figuring out what to do. Her doctors, who are good, have said they have never seen anyone like her: she is Type 1 and her body can't handle more than 1 unit of insulin. A week ago, she was running high and her mother gave her 1 unit of Humalog. Her sugar went from 450 to 43 in 2 hours. Needless to say, she had to get her to an emergency room. Fortunately her mother was able to get her sugar back up before they had to do any intravenous feeding. We are just wondering if there any other cases out there of children whose pancreas seems to be working and insulin intake is so erratic.

Answer:

It is somewhat unusual for a young child with Type 1 diabetes to be able to go for a year without insulin during the remission or honeymoon phase, though occasionally this can happen. Many doctors would want to give her a little bit of insulin any way during this time to try and prolong the remission phase.

First of all, you might want to have her blood tested for antibodies against the islet cells to confirm that she indeed has type 1 diabetes. In any case, if her blood sugars are high, she probably needs some insulin every day even if her blood sugar is not high. I have seen many young children who are extremely sensitive to lispro insulin [Humalog® brand] and cannot tolerate one unit at a time even if their blood sugar is very high.

I would suggest that you discuss with her physician possibly diluting her insulin so you can give less than 1 unit at a time and make small changes. You can obtain special diluents for Regular, NPH, Lente, or Ultralente free from Eli Lilly. At the present time [November 1997], no diluent is available for Humalog. If she is very sensitive to NPH and goes low before lunch even is she takes no short acting insulin such as Regular or Humalog before breakfast, she may do better on a small amount of Ultralente once or twice daily (diluted if necessary).

TGL

Original posting 5 Nov 97

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