Question from Milwaukee, Wisconsin, USA:

My granddaughter is 3 years old, 36.0 pounds, and eats a target 247.5 gm carb/day. She was diagnosed 16 months ago. Her current insulin requirement is 5 units/day, all NPH. It is my feeling that 5 units/day can not possibly be enough to metabolize 247.5 gm carb (less brain usage, etc.). Therefore, she must still be making some endogenous insulin.

She is very difficult to control: on any given day her blood glucose typically varies 200�-�300�mg/dl. When I suggested the partial endogenous mechanism to my daughter-in-law she seemed incredulous. I described it as a partial honeymoon. She doesn’t seem to think there is such a thing. She views a honeymoon as all-or-nothing.

Could you steer me to references on how to manage a child who requires very low insulin dose?