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Question:

From St. Louis, Missouri, USA:

We have a 5 1/2 year old with Type 1 since age 2. She has started kindergarten this year, and we are trying to figure out what could be the best regimen for her insulin. Our physicians say we are doing fine, but we still have problems, and are doing ok mainly because my wife goes to school with her every day, and takes care of crises! (School personnel are willing to help, but that is not the problem.)

The problem is that she gets N and R in the A.M., then R at dinner, N at night; because of variable activity, food/snacks etc., she gets highs over 350, lows in the 50's. No steady pattern to those numbers. Lows are easy to treat, so far, since she actually is pretty aware, and gets glucose or food. Highs are actually a big problem, because her behavior, normally excellent, deteriorates rapidly. Again, one of us has been there, and dealt with it, but that is not a tenable solution. We are not trying to be too obsessive, but we are just trying to figure out a regimen, and get any hints we can, on how people have coped with very young children in school--in terms of what insulin regimens folks are using, food routines etc. so that they can send their child to school with at least a minimum of worry, and a child that will not have a lot of problems.

Answer:

Your problem is a common one and I think it's probably worth reiterating the guiding principles of care of young children with diabetes. You cannot expect or attempt to achieve perfect blood sugar control. This is unrealistic in a child with very variable activity levels and food intake.

I am not in a position to offer you specific regimen advice but you need to discuss this with your diabetes team. However, swings from high to low and back again often suggest over insulinisation and I believe in keeping young children's regimens as simple as possible. For most it's perfectly reasonable to give twice daily injections. You certainly need to extricate yourselves from regular attendance at school as soon as possible because this is definitely detrimental to her development of any sense of independence from home.

KJR

Original posting 23 Feb 1998
Posted to Insulin and Social Issues: School and Daycare

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