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From Santa Barbara, Calif, USA:

My son is 12 years old and has been insulin dependent since he was 6. We just recently were told he wasn't growing and needs to be on thyroid pills. He also is not taking very much NPH at night time and we were told he should be taking more for his age and weight. Is this common?


Underactivity of the thyroid gland is a common problem in children with diabetes and is usually easily treated with thyroid pills.

Although the average child who is no longer making much insulin usually requires approximately 1 unit of insulin per kg of weight per day (or approximately 1/2 unit of insulin per pound of weight per day), there are many factors that can change this requirement. On an average, children taking intermediate insulin twice daily (usually along with a fast acting insulin) need approximately 2/3 of this total daily dose in the morning and 1/3 of this total daily dose in the evening. Again, however, there are many factors that can change this proportion of insulin.

If the blood sugars are under control and growth and weight gain are normal, you should not worry if your child is not taking "average" doses. If the blood sugars are not under control, it is important to look at the total daily dose and the distribution of the insulin. When the total daily dose or the distribution is far from average, sometimes the "rules" of insulin adjustment don't work. For instance, if the total morning dose is much more than twice the total evening dose, the morning dose may last longer and significantly overlap the evening dose causing lows during the evening or night (instead of during the afternoon which you would normally expect). If the evening dose is then lowered excessively to prevent lows during the night, there may be less carry over of the evening dose into the morning and the blood sugars before lunch or sometimes even before supper may paradoxically go too high (instead of before breakfast as you would expect). In this case, lowering the morning dose and raising the evening dose pay improve the blood sugars even though this seems to go "against the rules".

It is important to work closely with your child's own physician and pay close attention to which blood sugar(s) during the day changes as the insulin is changed to spot confusing situations such as this.


Additional Comments from Linda Mackowiak, diabetes nurse specialist:

If your child has had an underactive thyroid (hypothyroidism), when this condition is treated, your child's insulin needs will likely change.


Original posting 12 May 1998
Additional comment added 18 May 1998
Posted to Thyroid


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Last Updated: Tuesday April 06, 2010 15:08:58
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