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From New Jersey, USA:

I have a toddler with diabetes who is skipping meals. My son was diagnosed with type 1 about ten months ago, and is now 2 years, 3 months old. He occasionally will not eat meals or snacks. His blood glucose has never been very stable but he has been bouncing very high and low for about a month. I purchased the book you folks recommended and I still can't figure out what to do in certain situations. Today my son was 430 at lunch (200 at breakfast but wouldn't eat much so didn't get Humalog). He would not eat lunch so my wife let him take his nap without giving him insulin. He recently went on Humalog and gets it after he eats. He gets 7u pork NPH every morning. For meals and bedtime he is on 3 different sliding scales of Humalog (the same as when he was on pork regular). We refrigerate his insulin and change it every 2 months. What would you have done? We have asked this type of question to our CDE and pediatric endocrinologist several times but they really are at a loss for specific advice.


You mention you change your insulin every 2 months. I believe the instructions in the insulin say to change the insulin in 1 month after it has been open. That could be a contributing factor. I am not sure if the book you are referring to is Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace or Stop the Rollercoaster. Either may give you good information.

I know that children in this age group can be very challenging. Sometimes one has to take the stance that "this too will pass" and concentrate on keeping family life as normal as possible. Children often pick up on parent's frustrations and "push the buttons" to get a response. A few questions you may want to ask: Are you begging your child to eat? Are you fixing multiple meals and snacks in hopes your child will eat something? Are you focusing on the diabetes and blood sugars to the exclusion of almost everything else in the household? If you answered yes to any of these questions you may want to rethink your approach. The book Sweet Kids has several solutions to this problem. It seems your team has pretty much taken care of the risk of a seizure by suggesting you give the insulin after the meals based on what your child ate so the fact that the numbers are everywhere may not be of as much an issue right now. 200 to 400 blood sugars can be expected in this age child - emotions, growth, etc. I know it is difficult, but try offering two choices of things to eat and if your child chooses not to eat, honor that choice, but stick to your meal and snack schedule. Allowing your child to "graze" and not eat meals and snacks sets you up for trouble for a long time. Keep asking for help from your team which I hope includes a pediatric dietitian. She can help you with suggestions along the way that may help you keep your sanity.


Additional Comments from Linda Mackowiak, diabetes nurse specialist:

If I read your question correctly, your child is receiving the NPH once a day. Talk to your doctor about splitting the NPH to twice a day or more (for example morning and night, or morning and noon and night) to smooth things out. Sometimes if too much of the daily insulin is given as Humalog (especially in little kids) I find that you get more ups and downs as the Humalog starts to work fast and also goes away fast. Don't make any changes without your diabetes team's involvement.


Original posting 4 Oct 1998
Additional comment added 10 Oct 1998
Posted to
Meal Planning, Food and Diet


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Last Updated: Tuesday April 06, 2010 15:09:00
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