My eight year old daughter has recently been diagnosed with diabetes and is on an insulin regimen of twice daily NPH and Regular. I monitor her glucose levels with a meter, and her evening sugar levels are most often in the range of 250-320 mg/dl [13.9-17.8 mmol/L]. We strictly control her diet, giving her small frequent meals six times a day. How to control these levels? Does a better breed of insulin exist? Is there any possible way to give her the dosage without pricking, i.e orally, tablets, mixtures or inhalers?

I’m a really worried father because eight years is an age when a kid wants to enjoy candy and other stuff like that. She has a long way to go, and I hear that some times high sugar levels cause renal and vision problems as well. Please guide me so that a father can guard his kid in the most effective manner.

The most important thing for you to do for your daughter is to get lots of blood glucose readings. This will allow you to know how and when her food or insulin doses should be changed. We usually use four or five smaller injections of insulin, generally with Humalog before each meal and NPH before breakfast and again at bedtime, but every child or adult is different and we use the blood glucose levels as a guide to individual needs.

You should work very closely with your daughter’s diabetes team to know what possibilities exist where you live, what needs to change according to her growth needs, eventual puberty needs and at different seasons. Exactly which insulin you use is less important than controlling the blood glucose levels. Long term control of blood glucose levels produces far fewer long term complications so that this should be your goal without excessive or severe episodes of hypoglycemia.

Excellent teaching manuals are Insulin-Dependent Diabetes in Children, Adolescents and Adults – How to become an expert on your own diabetes written by Dr. Ragnar Hanas and Understanding Insulin Dependent Diabetes [which can be downloaded over the Internet at no charge] by Peter Chase. You should get these, if possible, so that you are well aware of treatment possibilities for your child.

SB