From Enumclaw, Washington, USA:
My 14 year old son, diagnosed 21 months ago with type 1 diabetes, uses Lantus at bedtime and Humalog with carb counting for all meals/snacks. He gave up his bedtime snack some time ago because he hates eating that late and was bored with his choices. We didn't notice a problem with this until recently, I realized the more frequent problems with morning headaches and ketones were probably caused by rebound. His morning glucose was still within normal range, so it took a while to make the connection, but I now have him eating at bedtime.
His A1c was 11% last week, and we were shocked. He hasn't been in good control since diagnosis, but even his last A1c was 9%, so we felt with the new insulin regimen (four months) and careful monitoring, it would be better. Is there a connection there? Would we see a result is we requested another test in a month? Could this have affected his A1c?
It seems that your son is on the most up to date insulin regimen, yet something is wrong as shown by his hemoglobin A1c values which are unacceptably high and indicate insufficient insulin. I would be inclined to start by developing a profile of blood sugar levels throughout the 24 hours for at least three days. This should be able to tell you when blood sugars are high and when, if at all, they are low.
His total daily dose of insulin at this stage should be of the order of 0.8 units/kilogram of body weight per day of which a little less than half is usually required for the Lantus (insulin glargine). The before breakfast blood sugar (after what is probably an eight hour fast) is then a good index of how well the bedtime Lantus is adjusted. Meals of course are covered by the Humalog and here you might consider doing both before meal and two-hour postprandial blood sugars for a few days to get the dose right. It might be an idea too to give the insulin right after the meal so that you can take into account the premeal blood sugar level as well as appetite. Remember too that the amount of insulin needed per gram of carbohydrate may also vary.
I think it is important that so far as possible you do the testing yourself. Of course, you do need to coordinate any changes with the doctor. All this will take time and patience and also a lot of finger sticking so that it might be worth switching to one of the meters like the FreeStyle or One Touch® Ultra which are essentially painless.
Finally, you might be helped by having at hand one of the many good practical manuals. See Books for Parents, Adults and Older Kids.
I don't think you need have another A1c done for at least two months because you will be able to assess control on the basis of more frequent blood sugars.
Original posting 23 Mar 2002
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:09:32
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