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Question:

From Copenhagen, Denmark:

We are trying to understand how insulin works in order to treat our daughter best as possible. We have a number of questions. She is 6 and has been diagnosed with diabetes type 1 for two months. Currently we give her 8 units of 30/70 insulin (short/long acting) per day - in the morning. Her weight is about 20 kilograms and she is lean. This generally keeps her blood sugars in the 7-10 mmol/l range.

Question 1: Is this the kind of dose she'll settle with when the honeymoon period is over?

Question 2: Please explain if there is a direct relation between sugar intake and insulin doses. I think there isn't, but need something more specific to understand the process.

My understanding is that Insulin "opens" the cells so that sugar can "go into them". The insulin isn't used in this process, but is rather keeping the cells "open" for a limited time. Is this correct? Or sort of correct?

Question 3: Counterreactions. We have noticed that if she goes to bed with a blood sugar level less than 10 mmol/l, she'll wake up with more than 15. And if she goes to bed with more than 10, for example 13, she'll wake up with a blood sugar around 6-8. Is this her body counteracting. How can we compromise this best as possible?

Other readers are welcome to write to us.

rolf@pip.dknet.dk

Answer:

Question 1. When the pancreas no longer is making insulin, a pre-pubertal child needs on an average of 1 unit/kg of insulin a day. As your child grows and makes less insulin, you will need to increase the dose. You may also want to mix Regular and NPH yourself, rather than use a fixed premixed preparation so you can change each insulin independently.

Question 2. The more carbohydrate you consume, the more insulin you need to keep the blood sugar normal. The relationship is not always linear. Insulin binds to special receptors on the outside of cells which then activate a complex process regulating the entry of insulin into the cells. Only some cells require insulin for glucose to enter.

Question 3. I would be concerned that your daughter's blood sugar may be dropping during sleep and going low during sleep when her blood sugar at bedtime starts off in the normal or slightly above normal range. Her body than may be releasing stored sugar from the liver to counteract a low blood sugar causing her to wake up high (rebound hyperglycemia or Somogyi effect). I would suggest testing your daughter's blood sugar every few hours during the night. If her blood sugar is dropping during sleep, you should discuss with your child's physician either changing the timing of the evening NPH, switching to Ultralente in the evening, increasing the bedtime snack, or having a snack at bedtime higher in protein or uncooked cornstarch to prevent this drop in blood sugar (In the US, chocolate and peanut butter bars are available that contain uncooked cornstarch. They are called Nitebites. You can also add uncooked cornstarch yourself to milk, pudding or yogurt.)

TGL

Original posting 28 Jan 98

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