May 20, 2004
Exercise and Sports, Hyperglycemia and DKA
Question from Montcalm, West Virginia, USA:
My 12 year old daughter has been having very good blood sugars, such as 124 mg/dl [6.8 mmol/L] and 79 mg/dl [4.4 mmol/L] at meal times. Since she is becoming very active outside, I was cutting back on her insulin. She takes 15 units of Lantus and a sliding scale of Humalog, but then I got concerned about ketones. The doctor said to make her eat more, but my daughter eats well already. She was swimming in our pool and I gave her a granola bar. When she got out her sugar was 180 mg/dl [10.0 mmol/L]. At dinner, it had gone up to 375 mg/dl [20.8 mmol/L]. I gave her eight units of Humalog at 6:00 p.m. She went back out to play, no swimming, just goofing around and at 7:00 p.m. her sugar was 46 mg/dl [2.6 mmol/L]. She ate a good size portion of spaghetti. Would the reduction in the Lantus make a difference? The lows scare me to death and I tend to overcompensate. She is on five shots a day, one with each meal and one at snack time, plus Lantus at bedtime.
Answer:
Unfortunately, you have not given enough data to determine a pattern in your daughter’s blood glucose levels. Furthermore, this forum is really not designed to make specific recommendations, especially those that might involve specific insulin dose changes. You should maintain a dialogue with your current diabetes team.
I will add, however, that perhaps you should talk to your diabetes about consideration for discontinuing or adjusting the “sliding scale.” Perhaps you are ready to dose the short-acting insulin based on her actual carbohydrate consumption at meals and snacks rather than a more arbitrary sliding scale.
DS
