April 8, 2004
Daily Care, Meal Planning, Food and Diet
Question from Tempe, Arizona, USA:
My young son was diagnosed a little over a year ago with type 1 diabetes. Since then he has been on a daily regimen of testing his blood sugar four times a day and insulin injections three times a day. His carbohydrate allowance, as set and monitored by the local children’s hospital staff, is roughly three blocks of 50-60 grams of carbohydrates, morning, noon and evening. His insulin is currently at 3 Humalog, 10 NPH in the morning, 1 Humalog at dinner, 1 NPH at bedtime, with adjustments as necessary if he is outside their prescribed range of 80 to 200 mg/dl [4.4 to 11.1 mmol/L]. We have been fairly successful in controlling his sugars, with his last hemoglobin test result at 7.1. He is four and a half years old and 55 pounds, but not considered obese by his doctors. He is a large boy and has considerable muscle mass for his age.
Recently, my spouse took him to see a doctor that specializes in diabetes care, but is not affiliated with the hospital. This doctor is recommending a therapy of three types of insulin: Humalog, Regular and Lantus, in addition to cutting his carbohydrates to about one-fourth of what they are now and removing a host of foods from his diet. These foods include fruit, milk, wheat, cereal, etc. This therapy is based on the research and book Diabetes Solution by Richard K. Bernstein, M.D.
This seems like such a radical departure from his current therapy, which really frightens me. Would you please offer another point of view on this approach?
Answer:
Dr. Bernstein’s approach has been available for several decades with good results in adults, but not much tested scientifically in children. If the A1c level is in the high 6 percent or low 7 percent range, without significant hypoglycemia on your current regimen, and especially if there is also no nocturnal hypoglycemia, then there is little scientific reason for changing your approach. There is no known ideal treatment regimen and the practical aspects of care must be taken into account in addition to the theoretical aspects of any intensified treatment regimen. We frequently use Lantus at bedtime and sometimes twice a day coupled with boluses of Humalog around mealtimes with excellent results and minimized nocturnal hypoglycemia and have replaced the overlapping NPH doses in such fashion. Go back and talk to both doctors and then decide which makes the most sense.
SB
