My 10 year old son, diagnosed with type 1 diabetes about three months ago, is NPH with Regular (total: 8 Units per day) at breakfast and dinner, and his blood sugars range 80-285 mg/dl [4.4-15.8 mmol/L] with an average of 140 mg/dl [7.8 mmol/L]. He is very active and still in the honeymoon period. He is carb counting and very responsible, but we are still seeing these big swings. Is he a candidate for pump therapy? Do doctors usually wait until patients are out of the honeymoon to start a pump?

Personally, I would suggest learning more about the reason for these volatile blood sugars before starting on an insulin pump. Your son is on a very low dose of insulin with only 8 Units per day six months after diagnosis, but with average blood glucose levels 140 mg/dl [7.8 mmol/L], I wonder, first of all, if he isn’t beginning to move beyond the honeymoon period and need more insulin, with the average established need being about 0.8 Units per kilogram of body weight per day.

R and NPH are now a little out of style in these days of aiming for the best possible control. I think that to start with you should talk to his diabetes team about using the newer Humalog or NovoLog at meal time. They are very rapid acting and have the important advantage that they can be given just after a meal and the dose adjusted for the ‘carbs’ actually consumed as well as for the pre-meal blood sugar. It is often possible at the same time to avoid a lunch time injection by giving some NPH with the morning insulin. The rapid-acting insulin is then given before supper and another new insulin called Lantus (insulin glargine) before bed. The latter is essentially equivalent to the basal dose with a pump and acts evenly form 24 hours. This will mean one more injection a day, and, at least for a time, some more frequent blood sugar testing. For that reason, you might like to consider one of the almost painless alternate site meters.

DOB
Additional comments from Dr. Larry Deeb:

I just saw a family who reminded me I made them wait about a year before the pump. They were so grateful that they learned diabetes before they had to learn a sometimes cantankerous device.

LD