From Tulsa, Oklahoma, USA:
Our 15 year old daughter, who has been in a honeymoon for two years and takes 1 unit of Humalog and 4 units of NPH at 6:45 am and 5:30 pm, experiences lows of 40-50 mg/dl [2.2-2.7 mmol/L] at 8:30 am. We are confused because at 7:30 am her blood sugars can reach 195 mg/dl [10.8 mmol/L], and the rest of the day is great. She eats a snack at 8:00 am. Any suggestions? What is the best way to solve mid-morning lows?
Congratulations to your daughter on having such a prolonged honeymoon. Your daughter is not on a lot of insulin for her age! There are a several different options that I can think of:
You might want to discuss these options with your daughter's diabetes team to find which would be the best for her lifestyle.
- Add increased protein to the bedtime snack, or consider a long-lasting starch such as cornstarch (commercially available in such products such as Extend).
- "Split-out" the evening dose of NPH to be given at bedtime. This will delay the peak effect by a couple of hours.
- Change from NPH in the evening to Lente, as Lente has a slightly later peak than NPH.
- Consider switching to a regimen of long-acting Ultra-Lente (usually given twice-a-day) or Lantus (insulin glargine) (given once a day at bedtime) to provide a basal level of insulin with less peaking. However, then she would require short-acting insulin (Regular or Humalog or Novolog) with each meal and possibly snacks. Ultra-Lente can be mixed with other insulins; Lantus cannot be mixed. This is sometimes referred to as Multiple Daily Injections (MDI).
- Consider an insulin pump.
Original posting 28 Sep 2001
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:09:26
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