October 10, 1999
Daily Care
Question from New Jersey, USA:
My son is 10 years old and was diagnosed with Type 1 five months ago. Recently he has had some high readings in the morning and the evening hours. I discussed this with his doctor and he adjusted his insulin from 6N-6R to 7N-6R in the morning and 5N-2R to 6N-2R in the evening. My ex-husband disagreed with the changes after speaking with some people with diabetes and also some nurses he knew and felt we could control it if we just adjusted our son’s diet. I know I am giving my son the exact amount of carbs for each meal and snack and I agree with the doctor about the adjusting of the insulin. My ex will continue giving our son the original dosage when he is with him.
Am I harming my son by giving him the additional insulin or could my ex be harming him by not giving him the additional insulin?
Answer:
In general, it is better to manage any person’s diabetes by adjusting insulin according to one’s lifestyle. Also, in children it is important to remember that they are growing and so will need an adequate amount of energy intake to allow them to grow normally. It is not usual to alter food intake to ensure that blood glucose is well controlled (unless food intake is excessive and of the wrong types).
By limiting food intake in the evenings, this will potentially put a person at a slightly greater chance of having low readings overnight. Also, it may make that person feel more hungry if they are not getting enough food!
JS
Additional comments from Dr. Lebinger:
It is also extremely important not to use the child’s diabetes as a source of disagreement between divorced parents. I suggest that you work out a way that both parents can work with the child’s doctor, dietitian, and educator to agree on the child’s care. It sounds like meeting with a social worker, family therapist, or psychologist may also help smooth things out. If both parents can’t come to appointments together, perhaps the parents can alternate who brings the child, or if this is not possible, at least ask for more specific recommendations in writing that everyone agrees to.
TGL
