From Sturgis, Michigan, USA:
My seven year old daughter, diagnosed with type 1 diabetes just about six months ago, is on Humalog and Lantus, and we are working hard at counting carbohydrates (which is quite a challenge). When we actually get her two hour post meal blood sugar in the target range of 80-160 mg/dl [4.4-8.9 mmol/L], we are very happy, but then she usually drops below 60 mg/dl [3.3 mmol/L] about 90 minutes later without an increase in activity to justify this. Since she is on Humalog, I know snacks are not required nor do I want to feed her just to keep her number up. Could she be needing more Lantus at night? Is there something else we need to do?
This is an excellent question. As you allude to, the purpose of your daughter's insulin regimen of Lantus (insulin glargine) and Humalog is to allow more intensive therapy yet allow the flexibility required to better fit diabetes into her daily life rather than "her life into diabetes." At age seven and only diagnosed within the past six months, your daughter is presumably still in her honeymoon.
If she is often dropping lower than your target within three and a half hours after a meal, I do not think you should have to give her a snack unless that is what she would prefer with her daily routine (that is, you should not have to routinely "chase" the low glucose). I think that at this stage of her diagnosis you might ask her diabetes team to consider:
- Slightly decreasing her insulin-to-carb ratio for those meals in essence allowing the two hour postprandial level to be a bit higher knowing that the values often continue to go down as you describe. I am assuming that her hemoglobin A1c is within the target and certainly less than 8%.
- I don't think an adjustment in her basal Lantus is required, based on your description.
- Are you counting the "two hour" mark from the beginning of the meal or the end? The beginning of the meal is when your timing should start.
- You could be certain that her meals have a bit extra protein to try to prevent the later low.
Original posting 24 Jul 2002
Posted to Daily Care
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