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From Florence, South Carolina, USA:

I have a 23 month old who was diagnosed at 13 months with Type 1 diabetes. For a while, we were doing good with her blood sugar levels. We would be great for a few weeks and then her numbers would go haywire for a couple of weeks. For the last 2 months, her sugar levels, I feel, have been out of control. They can range in one day from 40 to 400. I have a fantastic doctor and I believe she is doing the best she can. We moniter closely what and when she eats, but cant get the numbers under control.

Do you have any suggestions that I may discuss with her doctor that might help us? We are on NPH, Regular and some Humulog and are trying all variations and different times and still can't get it. I would appreciate any suggestions.


The key to diabetes is consistency. I understand your frustrations since at times the only consistency is that the condition seems inconsistent.

A few recommendations:

Test more often. This will give your more information to work with. Blood sugars in diabetics have a wide range, as has been shown in the data done by Minimed with their new invasive, subcutaneous glucose monitor. Often times we are testing 4 times a day and the blood sugars looks like they are within range; however they may be fluctuating outside of range at the times we aren't testing.

Rotate injection sites. Insulin absorbtion is more variable than we'd like to believe. Sometimes insulin takes a longer or shorter time to get to where it's effective.

Test blood sugars one and two hours after introducing a new food. The "carb counter" might say 2 ricecakes for 1 carb, but your child's blood glucose level rises as if 2 carbs were eaten.

Try not to overtreat lows or highs.

Spot dosing is not recommended at our diabetes center and many educators discourage spot dosing in very small children. It will also complicate your ability to evaluate your morning and evening doses.

If you use Humalog, you can wait to see what a small child actually eats and then dose them immediately after their meal.

Be patient with yourself and your child. Diabetes is especially difficult in small children since they can be such picky eaters and their activity levels are unpredictable. Remember that growth hormone works against insulin, so growth spurts (which are constant in this age group) can affect your insulin dosing.

Set a goal with your health care team for percentages of normal, highs and lows over the long run, say a week's time. Give yourself credit for the things you're doing right.


Original posting 26 Mar 1999
Posted to Daily Care


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