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April 12, 2007

Daily Care, Hyperglycemia and DKA

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Question from Inchon, South Korea:

My 14-year-old younger sister was diagnosed with diabetes about a month ago. She was on Lantus and Humalog, 28 units of Lantus and one unit of Humalog for every 10 grams of carbohydrates. Her two hour after meal blood sugar is around 130 mg/dl [7.2 mmol/L] to 150 mg/dl [8.3 mmol/L], but before meals, her blood sugar is 200 mg/dl [11.1 mmol/L] to 250mg/dl [13.9 mmol/L]. I think these numbers should be reversed. How can she fix this? Why are her pre-meal blood sugars higher that her post-meal sugars?

The other day, in the morning, before breakfast, she was 95 mg/dl [5.3 mmol/L]; two hours later, she was 120 mg/dl [6.7 mmol/L]. Before lunch, she was 220 mg/dl [12.2 mmol/L]; two hours later, she was 105 mg/dl [5.8 mmol/L]. Before dinner, her blood sugar was 215 mg/dl [11.9 mmol/L]; two hours later, she was 119 mg/dl [6.6 mmol/L]. Just before bedtime, she was 232 mg/dl [12.9 mmol/L]. The next morning, she woke up at 98 mg/dl [5.4 mmol/L].

Answer:

From: DTeam Staff

It sure sounds like she is running out of rapid-acting insulin between meals. It might be hard to give more; you’d need to watch for lows. Your sister may need more long-acting insulin. Have her consult with her diabetes team about possible adjustments.

LD