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Question:

From Ontario, Canada:

My 12 year old daughter was diagnosed with diabetes 1 year ago; her anniversary is days away. Over the last three weeks we, her doctor and I, have increased her morning NPH from 29 units to 34 units because we have been getting readings of 17.0 to approximately 25.0 at suppertime. (These are metric measurements.) We also use a sliding scale when her readings are out of whack. There has been no change in her glucose readings. She has and probably is still going through a growth spurt, she grew approximately 1 inch in 3 months. I checked with our pharmacist and she assured me that we are storing and using her insulin in the correct manner. She regularly rotates her injection sites, uses the same type of syringe for each injection (B-D Ultra Fine II in the morning and then her pens at supper and bedtime). I am also very sure that she is not sneaking any food, she is as concerned about this as we are. We are seeing the doctor every week right now and are going back tomorrow morning. I'm sure he will be shocked to see her readings. Do you have any advice for us? We have complete confidence in her doctor, I suspect he might send us to the specialist in a nearby city; we see her regularly every 6 months.

Answer:

In the first year or two of diabetes, the pancreas often continues to make significant amounts of insulin (the remission phase). As the pancreas makes less insulin, requirements for injected insulin will increase. At the age of 12, your daughter may be in puberty. The hormones of puberty also increase the need for insulin. Frequent reevaluation by a pediatric endocrinologist experienced in the care of children during puberty is usually required. Food requirements may also increase, so reevaluation by a dietitian is helpful.

You do not mention if your child is taking any other insulin in the morning with the NPH or whether she is taking any insulin in the evening even when her blood sugar is normal in the evening (to prevent the blood sugar from going up.) At this age, usually at least 2 injections a day are necessary to adequately control blood sugar. Fast acting insulin (Humalog or Regular) usually is given with the NPH twice daily even when the blood sugar is normal so that you have at least 4 different insulins working at different times of the day. (You can also give extra Humalog or Regular if the blood sugar is high. This is called the "sliding scale method.")

I would strongly suggest you try to arrange a meeting with a pediatric endocrinologist as soon as possible to review your child's entire management plan. Consultation with a dietitian will probably be necessary. It would also be very helpful for your daughter and you to meet with a nurse educator. This is the age where the children need to learn more about diabetes so they can manage when they are away from home.

TGL

Original posting 11 Nov 1998
Posted to Insulin

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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