I am following a two month old with gestational diabetes in the home setting. The baby was carried to term but was diagnosed with intrauterine growth retardation, and her pancreas never worked. She is receiving a sliding scale of Regular insulin with twice daily Ultralente, and her blood sugars are still 400-500 mg/dl [22.2-27.8 mmol/L]. Is there an infant formula made especially for babies with diabetes that will promote growth, and nutrition and at the same time help with the very high sugars? Currently she is on Similac with Iron and taking four to six ounces every four hours.

There is no special formula for an infant with neonatal diabetes. For this reason, good control is likely to depend on the design of insulin therapy and on your ability to help the parents and the doctor adapt this for optimal control.

To begin with, you might ask the doctor whether he thinks a chromosome study might help as changes on the long arm of chromosome 6 could help to predict whether the diabetes might be transient or permanent. In the latter case, you might have to contend nutritionally with a diminution in the pancreatic exocrine or digestive enzymes.

You might also suggest using the new FreeStyle or One Touch� Ultra blood glucose meters, which are essentially painless. This is important because you are going to need to monitor frequently. The FreeStyle tracker comes with a Palm Pilot that is loaded with a nutrition program that would help with mixed feeding when the time comes.

Similac with iron every four hours five times a day is appropriate; but you again might want to talk to the doctor about changing to once a day Lantus (insulin glargine) for basal insulin needs. This alone might give improved control, but as a next step you might discuss adding a very small dose of Humalog or NovoLog at the time of the 6 am feed together with enough NPH to cover the bulk of the after feed rises in blood glucose at least until the 10 pm feed. Helping the parents to accurately measure small amounts of insulin may be a key part of your role.

DOB
Additional comments from Dr. David Schwartz:

Please be certain that you are using your terms correctly as it may have implications for the care of the child. The infant does not have gestational diabetes! She may have been born to a mother with gestational diabetes, but certainly, based on your description, she has neonatal diabetes. Close follow up with a pediatric endocrinologist is imperative! I assume that the infant is being followed by a pediatric endocrinologist in your city. If not, please get a referral to one.

DS
Additional comments from Dr. Stuart Brink:
There is no such diagnosis as a gestational diabetes in a 2 month old. If you are talking about neonatal or congenital diabetes, this is quite rare. This child should be seen by a pediatric endocrinologist with special expertise in diabetes management of such very young infants since their treatment is often extremely difficult. Sometimes only an insulin pump can be successful in handling these extremely labile youngsters.

SB