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From Arizona, USA:

My son is a very picky eater. He has wildly-fluctuating blood glucose levels. I need advice. He was diagnosed a month ago.


It is early days to have achieved the levels of blood sugar control in your son that are considered ideal. It would be usual for the whole family still to be adjusting to the discipline of injections, blood glucose monitoring and dietary regulation. To add to this you are all still learning the effects of stress, exercise and dietary variations on blood sugars at various times of the day and to make it all a little more complicated he may still be making some of his own insulin which however may be delayed in entering the blood stream after a meal making blood sugars too low.

There are several steps to be taking; but don't expect everything to fall into place right away. First of all you should talk to the nutritionist in the diabetic team that is looking after your son to make sure that his average three day food intake is indeed adequate and that you yourself understand how to substitute one food for another. Then you can discuss how his diet might be modified to make his intake more uniform without at the same time making it very different from the rest of the family.

Second you might talk to his doctor about using lispro insulin [Humalog®] rather than Regular insulin. You may of course already be doing this; but because of its more rapid onset of action and more limited duration of action (10 minutes to 4 hours), it is possible to give it right after the meal and in this way you can adjust the dose to the pre-meal blood sugar level as well as his appetite.

You might be helped by downloading an easy to understand text called Understanding Insulin-Dependent Diabetes. And finally you are going to have to set up a system for interpreting blood sugars. One day it may be possible to fine tune insulin dose much more accurately than we do now with hand held computers; but for the moment you need to do lots of blood sugars and to use a meter that stores the results, you can of course do this on paper. It is then a great help to plot out the results using the meter memory or a home PC using time of day versus blood sugar level. If you then eliminate all readings between 80 mg/dl and 180 mg/dl, you can then look at the lows and see if you can explain them on the basis of exercise, delayed meals or snacks or a dose of insulin that needs to be modified. High blood sugars can be due to matters like diet issues and stress. Another way to do this is to fax in the blood sugar results to your diabetes team to interpret; but it is much better if you can do this within the family.


Original posting 13 Apr 97


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