January 20, 2007
Daily Care, Insulin
Question from Mumbai, India:
When diagnosed with type 1, our 12-year-old was put on the following insulin regimen: pre-breakfast–four units of Actrapid, four units of Insulatard; pre-lunch–four units of Actrapid; pre-dinner–four units of Actrapid; and midnight–four units of Actrapid and four units of Insulatard. She had many high blood sugars, as high as 532 mg/dl [29.6 mmol/L]. Her Actrapid doses were increased to six units, which caused her blood sugars to fluctuate from 40 mg/dl [2.2 mmol/L] to 346 mg/dl [19.2 mmol/L]. Why is she having such swings in her blood sugar? What should we be doing differently? She has never had ketones.
Answer:
I think you would do much better switching her to an advanced intensified insulin regimen based on glargine as basal insulin once a day and lispro or aspart or glulisine as fast-acting insulin before meals. This, if properly applied, with the educational help of a trained diabetes team or a pediatric endocrinologist with experience with the care of young type 1 diabetic patients, is the best way to assure to her the most stable control of blood sugar levels over the entire day and across the coming years. So, please discuss this with your diabetes team.
MS
