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Question:

From Orange Park, Florida, USA:

My 11 year old son was diagnosed with type 1 diabetes two months ago. Our diabetes educator explained that we are trying to mimic the insulin production of the pancreas. However, on our sliding scale if his glucose is below 70ml/dl he receives no Humalog (breakfast and dinner) just some juice, his NPH, then the full meal. From what I can understand of a properly functioning pancreas, at a large meal there would be a bolus release of insulin to deal with the glucose. With NPH only, the glucose would be high until the NPH began peaking. It seems to me that I should give him a juice to raise his glucose within range then give the normal Humalog and NPH injection with his full meal to simulate the pancreas.

Answer:

Theoretically you are correct. Many people do not need to reduce the insulin they are about to take if they are low at the time of the injection. They just bring up the blood sugar with some juice and take the normal amount of insulin to balance the food they are about to eat. However, sometimes this does not work. Although the morning NPH may be peaking in the afternoon, some of it is usually working in the morning before lunch and overlaps the Humalog. In addition, some of the evening NPH may carry over and be working after breakfast also overlapping the action of the morning Humalog. Many people find if they start off the day low, they need less fast acting insulin before breakfast otherwise they will go low again before lunch. If your child is on a very low dose of Humalog, he may not need any on days he wakes up low as the morning NPH (perhaps combined with some residual effect of the evening NPH) is enough to meet his insulin needs after breakfast. If however, you find that when you omit the morning Humalog, he is higher than usual before lunch, you should discuss this with your doctor and decide if your son's program needs to be changed.

TGL

Original posting 10 Apr 1999
Posted to Daily Care

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