From Faisalabad, Pakistan:
My eight year old daughter was diagnosed with diabetes 18 months ago. She is on biosynthetic human Mixtard 70/30 insulin. She weighs 32 kilograms (70.4 pounds). I am giving her 18 units before breakfast and 12 units before dinner. I check her blood sugar level at least once a day, before I inject the dose. Usually, I find it to be on the higher side. She varies from 140 to 160 mg/dl (7.8 to 8.9 mmol/L) fasting and 170 to 250 mg/dl (9.4 to 13.9 mmol/L) before dinner. Here are my problems and questions for you:
- Is my Insulin the right one?
- Is the dose okay, if not how do I figure out the right one?
- Is the duration of dose okay? if not what can I do to control her blood sugar levels better?
- Are continuous higher side blood sugar levels dangerous? How may I interpret it?
- What should be the normal lab tests which I must do?
- It is difficult to stop her from eating cakes and sugary products when her cousins or friends are with her. If she does eat should I increase the dose or is there anything else I can do?
- Can my daughter, at her age, have an insulin pump?
- Is pancreas transplant still a dream, or it is becoming reality?
- The 30/70 mix of regular insulin/NPH would not normally be used these days in North America. More probably, it would be a variable lispro dose after each meal and one or two doses of Ultralente or NPH.
- Blood sugars should be done just before every meal and at bedtime. An occasional reading in the middle of the night is also helpful. This will allow you to make appropriate changes in insulin dosages.
- 30 Units of insulin total for a 32 kilogram child, is if anything, a little bit high, but not beyond the normal range. However, it does suggest that there is perhaps a dietary reason for the somewhat high blood sugars.
- I wonder if your daughter is getting enough exercise.
- Over a long period, poor control of blood sugars does make microvascular complications more likely.
- You should talk to your daughter's doctor about getting a Hemoglobin A1c level done. It is the best indication of average 24 hour blood sugar. The test should, ideally, be done every three months and should not be higher than slightly above the upper level of normal.
- A hard problem, but, rather than increasing the insulin, you should try to see if free sugar in cakes, etc., can be reduced in both your own house, and, when she goes to friends, in theirs too. Another approach is 'counting carbs', where 'treats' can be compensated for by reductions in other parts of the diet or adding extra insulin.
- Pumps have been used successfully in children as young as three, but it is important, especially in the beginning, to be linked up with a diabetes care team that has had a lot of experience with children. I don't know if there is one in Faisalabad.
- Both pancreas transplantation and islet cells transplantation can now be done successfully. However, at the moment, they are not recommended for children because of concern over the long term use of immunosuppressant drugs.
Original posting 13 Sep 2000
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:09:12
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