From Okinawa, Japan:
My 8 year old daughter has had diabetes for 2 years. We have always had a problem keeping her blood sugars between 100-150. She is always either high or too low (50-500). She is currently on NPH and Regular in the morning and NPH and Regular at night. Her morning blood sugars are okay. It is the ones from her lunch check and on that are over 200. It worries me about the long term effects to her body.
Would the new insulin Humalog be an option for her since she runs so high at her snack and meal times? Her overall HbA1c's are usually good but I fell that is because she has enough lows to cover the highs. But I know that is not good for her. Any advice would be good, so that I may talk it over with her health care provider.
The questions that you raise are interesting in the first place because they touch on the difficulty of reaching perceptive conclusions from a large accumulation of blood sugars. This, of course, is the driving motive for the many centers, especially in the U.S. and Britain, that are trying to harness computers to the task of more accurately predicting insulin needs.
In your case, the main issue seems to be erratic blood sugars from just before lunch to bedtime with generally good morning blood sugars and A1c's. Some points that you might think to discuss with your daughter's health care provider are these: First you might, if you don't already have one, think of getting a new memory meter, such as the One Touch Profile or an AccuChek Advantage, as your meter. These instruments have the advantage that they can store about three months of readings and that the memory can be downloaded onto a personal computer either at home or in the doctor's office to give a more detailed overview of blood sugars. That is to say, they can be divided by day of the week, into percentage high and percentage low and you can see a scattergram of all the stored values.
Ideally you might look at these printouts in relation to a number of other issues:
- Do the fluctuations in blood sugar relate to exercise patterns, particularly in the afternoon (e.g., soccer games, gym etc.)?
- Do they relate at all to the menu for school lunch, and
- Do they relate to particular teachers or particular subjects on the day in question.
If the errant blood sugars are both high and low then simply increasing the morning NPH would not be a good way to go. Another possibility which you asked about would be to change to lispro insulin (Humalog® brand). This has a more rapid and shorter action than ordinary Regular insulin. If you were to give it three times a day at meal times together with one dose of long-acting insulin either in the morning or before supper. There are a number of variants to this 'intensive insulin therapy' which you would have to discuss with the doctor; but the important advantage is that you can give Humalog right after the meal and so adjust the dose for pre-meal blood sugar, for appetite and for anticipated exercise. This should hive you much greater control over the lunch time to supper time period. You also of course have to consider whether you might be pushing meticulous control a little too hard for an eight year old.
Original posting 27 Jan 97
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