My 30 month old niece has type 1 diabetes. The child developed sudden erratic eating habits. Sometimes she eats everything on the table, sometimes hardly anything. She is on two daily injections of NPH. Now she has a roller coaster of hyperglycemia and hypoglycemia. How we can even out the glycemic control?

Having a toddler with their common erratic eating habits is hard enough. Add diabetes plus insulin into the fray and the results can be frustrating and scary.

Please speak with your own Diabetes Team about your concerns. Potential options might include lowering the dose of NPH but adding some faster-acting insulin or use of a “pre-mixed” insulin combination of intermediate and fast-acting insulin (in pre-determined, premixed ratios). Alternatively, the use of a “background plus meal” insulin plan with an even longer lasting insulin, but which may not “peak” as much as NPH might be helpful, in conjunction with a very rapid-acting insulin that would be taken with the meals and dosed based on the actual food consumed (rather than dosing before the meal and hoping the child eats!). In a 30 month old, the commonly used background insulin, called Lantus, is not an FDA-approved indication, I don’t think, but your doctor might wish to pursue it.

Some would consider an insulin pump in this instance but, generally, I think that pumping is used best AFTER a family learns to dose insulin by injection based on food consumption and “carbohydrate counting.”

DS