My daughter was diagnosed with type�1 diabetes one month ago and is currently on NPH with NovoRapid. We visited a doctor who prescribed an extremely low carb diet (less than30 grams per day), and her sugar levels are normalized but she has been spilling 1+ ketones for the past week. I am told it is no problem to spill ketones and that the NPH with NovoRapid should be switched as one always becomes resistant to it. What we like about this is the pen which has one-half unit increments but are being told that these are not small enough given her weight, and we should actually be diluting the insulin.

Is the low carb diet okay for a growing kid? Is what we were told about the ketones true? Should we really be switching to another insulin (Ultralente, Humalog, Humulin R)?

You should work with your diabetes team to really answer these questions. There is not much information about low carb diets such as the one prescribed for your daughter. Some research is just being started but mostly there is anecdotal information about their success. There is also very little information about such diets in kids/teens.

Most standard approaches would use about 50-60% carbs, mostly complex carbs and teach carb counting to figure out how much insulin to administer. The program that you are using is a reasonable one. The only way to know if it is working is to look at hemoglobin A1c results and then also look at day to day blood glucose profiles to figure out if the pre and postprandial readings are reaching your target glucose goals without excessive or severe episodes of hypoglycemia. Ultralente with multiple Humalog or NovoRapid boluses before meals would also work as would Lantus (insulin glargine) as basal insulin instead of Ultralente or NPH. Overlapping doses of NPH would also work, as would an insulin pump. Go back to your daughter’s diabetes team and determine together with them about target goals and then how to consider reaching them.

SB

[Editor’s comment: The comment that “NPH with NovoRapid should be switched as one always becomes resistant to it” is simply untrue.

WWQ]