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I have two daughters (10 years old) (identical twins). They have had diabetes since they were two years old. We use Lilly Regular and NPH. I have a formula that I use to determine the amount of Regular to give them (depending on their glucose number) and the NPH stays relatively constant. The higher the number, the more Regular I give them. Recently, their blood sugar levels are becoming more difficult to control. Their number does not come down fast enough as we would like. The girls are starting to mature. It doesn't seem to matter if I give them more Regular or more NPH. It actually seems to take longer for their number to come down if I give them more Regular or NPH. It's as if their body cannot process the insulin fast enough if I give them more. Can you give me any advice on this situation?


In puberty, insulin requirements can increase rapidly. If you are trying to mainly control the high blood sugars by covering with extra regular, you may not be thinking about increasing the insulin taken before the "high blood" sugar to prevent the high blood sugar. Sometimes, it helps to stop "covering" high blood sugars with extra regular for a while, and see what the pattern is on the "usual" daily dose of insulin, so you can adjust the "usual" dose of insulin to try and prevent the highs. (Of course, if your child is spilling ketones or is sick, extra coverage may be temporarily necessary.)

A few points to keep in mind:

The higher the dose of insulin, the longer it lasts. If you find you need their fast-acting insulin to work faster than Regular, you may want to discuss with your physician taking all or part of the fast acting insulin as lispro (Humalog) which works faster and doesn't last as long as regular. I find Humalog often works better than regular for "extra coverage," even if you do not use it every day in you "usual" daily insulin regimen.

You should work closely with your physician (preferably a pediatric endocrinologist) to frequently readjust your children's insulin and consider other insulin regiments if necessary during this time of rapid growth and change.


Original posting 10 Mar 97


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