March 22, 2003
Daily Care, Insulin Pumps
Question from Michigan, USA:
My seven year old son has been on the insulin pump for eight months, and his blood glucose numbers are always high at lunch time at school. We have checked his basal rate, and it is correct. We have had to raise it, we believe, because of the stress that school causes. He is currently on an insulin/carb ratio of 1 unit per 20 grams of carb which is still not working. I am going to use a 1 unit per 17 grams of carb ratio this week and see what happens. At my son’s weight (59 pounds), the doctor says it is more common for him to have a 1 unit per 30 grams of carb ratio (which he does for the other meals).
Is it really uncommon to have to have such a high dose of insulin in the morning compared to other times of the day? What causes this?
Answer:
It is not uncommon for young children to be less insulin sensitive and need their highest basal rates and carb/insulin ratios in the morning. In order to figure out why his lunchtime numbers are high, it’s best to have him check at “snack” time (even if he doesn’t have a snack (at least two hours after breakfast). If that number is high, then increasing his morning carb/insulin ratio is the correct thing to do. If that number is in range, then you may need to increase his morning basal rate (assuming that he doesn’t have a morning snack). If that number is consistently low, then he may be rebounding up into the high range before lunch.
LAD
