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Question:

From Tucson, Arizona, USA:

My five year old daughter was diagnosed with Type 1 diabetes a year and a half ago. Her blood sugars have never really been controlled. Her doctors prescribed 2 to 3 units of Regular and 5 units of NPH regardless of her sugar levels. She ranges anywhere from 80 to over 600. What else can I do to help regulate her sugars besides control her diet better, which I feel I'm doing already? Her doctors tell me to regulate her diet which I already do and frankly I'm tired of feeling like I'm doing an inadequate job.

Should I just seek a second opinion about her treatment or just realize this is the best it gets? I don't see any other parents with this problem so I think it's just my daughter's body being very sensitive to any carbohydrates.

Help!

Answer:

Many young children experience random swings in their blood sugar levels no matter what you do. Blood sugars ranging from 80 to 600 sound rather extreme, however. Some children do better by first trying to establish a meal plan which emphasizes day to day consistency in the amount and timing of food and then try to match the insulin to the food. Other children do better by trying to figure out a formula to calculate how much Regular or lispro [Humalog® brand] insulin is required to match different carbohydrate intakes so the child can eat different amounts of food each day and try and match the insulin to the food. Either method can also use a sliding scale to give extra Regular or lispro to bring the blood sugar down if it is too high. This chasing the blood sugar (sliding scale) method sometimes backfires, leading to a scenario where the body can react to a rapidly falling blood sugar by releasing stored sugar in the liver and further raise the blood sugar (rebound or Somogyi effect). In any case, your child's "average" insulin dose will continuously change as she grows and needs both more food and insulin. It is important to work closely with a physician who will help you establish what works best for your child and help you change the dose and meal plan as needed to accommodate day to day changes in activity and long term growth.

TGL

Original posting 13 Jan 98

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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