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Question:

From Frederick, Maryland, USA:

Since my seven year old son's diagnosis with type 1 diabetes about three weeks ago, his doctor has taken him off of morning Regular insulin because of late morning lows, but his morning readings are in the high 200s and low 300s mg/dl [11.1 and 16.7 mmol/L]. The doctor says that those reading are okay, as long as they come back down by lunch time.

Is it okay to have readings that high after eating, or is this is indication that insulin is needed? What kind of numbers should I expect to see an hour after eating? I know that theA1c test will give us more information, but I don't want to wait that long. Is he at risk of future complications?

Answer:

You've asked some good questions and you seem to grasp the tenets of insulin actions and meal planning. Good for you.

Your son has entered (or is about to enter) the honeymoon phase of diabetes. Not to worry. These higher readings after meals are not expected to correlate with complications in the future. It takes years (perhaps at least four or five) of on-going, sub-optimal control to lead to complications. Your son's hemoglobin A1c is your guide there, remembering that it provides a determination of overall glucose levels over the previous two to three months. So, the next A1c may still be higher, since he's only had diabetes for such a short time.

I presume, based on your letter, that your son is now only on an intermediate acting insulin (like NPH or Lente) at breakfast. If so, my approach, in general would also be to not worry about these post-meal checks at this stage of the diagnosis or honeymoon. If the glucose readings are greater than 240 mg/dl [13.3 mmol/L], be certain to check the urine (or blood if you have that meter) for ketones because the presence of moderate-to-large amounts does warrant some swifter interaction.

You also need to work with your son's diabetes team about meal planning. If he has been placed on a typical three-meal, three-snack program, this may need to be modified since he no longer is on morning short-acting Regular. Some clinicians are using very fast-acting insulin (Humalog or Novolog) with breakfast. If you are actually providing a long-acting insulin, like Ultralente or Lantus (insulin glargine), then a fast-acting insulin with each meal would be very appropriate.

However, most seven year olds are on NPH or Lente in the morning, so I would suggest that unless you are told differently by your son's own diabetes team, that for the time being you need only check the glucose values before each meal and at bedtime, and not to check a mid-morning reading routinely.

DS

DTQ-20020121064044
Original posting 24 Jan 2002
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:30
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