From Fairview Park, Ohio, USA:
My 10 year old daughter was diagnosed with type 1 diabetes five months ago. Up until mid-February, we were giving her NPH and Humalog at breakfast and dinner. She was doing very well. On Valentine's Day, she woke up, immediately came downstairs for breakfast and promptly fainted and had a seizure. We called 911 and she was taken immediately to the hospital. Since this episode, we have not been able to get her blood glucose levels under control. She has had several periods of lows, from 40 mg/dl [2.2 mmol/L] to 60 mg/dl [3.3 mmol/L], usually at dinnertime or bedtime, and her body can no longer recognize them. This is very scary. Her blood glucose levels vary from day to day. She is now getting three shots per day, NPH and Humalog at breakfast, NPH and Humalog at dinner and Humalog at bedtime. We are testing a minimum of eight to ten times a day to make sure she doesn't go low. We have even been testing her at 3 a.m., although we haven't had a problem at that time of the night. As soon as it looks like her glucose levels may be stabilizing, they start climbing up again or fluctuating wildly. In the past week, she ranged anywhere from 80 mg/dl [4.4 mmol/L] to 350 mg/dl [19.4 mmol/L]. As we adjust her insulin, we are doing so in very small, 1 unit increments, and staying at that level for three to four days before making another change, if needed, to avoid any hypoglycemic episodes. We are very careful with carbohydrate counting and keeping to a pretty strict schedule as far as eating, shots, and sleeping goes. Her diabetes team is not sure what is causing this problem. Could it be the start of puberty? Do you think we would have better results on the pump or a Lantus/Humalog regimen? For some reason, her diabetes team is divided on this issue with one doctor saying put her on the pump and the other wanting to keep her regimen the same as it is now.
I wonder if you didn't have fluctuations before and just didn't know until you had the spell and started to test more often. Maybe not, but I wonder. That said, this is "practicing" medicine. I do subscribe to the practice of not doing things just one way because it is the way I do it. I see children referred with all sorts of management, some I would never have done myself, but it seems to work. Sometimes I have to try several approaches before one seems right.
Last Updated: Tuesday April 06, 2010 15:09:56
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