My 12-year-old daughter was diagnosed with type 1 on in early December 2007 and started on 17 units of Lantus and one unit of NovoLog for each 10 grams of carbohydrates. Since we have been home, we have had to decrease her insulin. She is now on 11 units of Lantus and one unit of NovoLog for each 25 grams of carbohydrates and still running low right before a meal. Is this normal? What other corrections can be made to prevent the low numbers that happen four hours after a meal?

I cannot answer such questions without a huge amount more information. But, you should call your diabetes team and let them help you with either food and/or insulin adjustments. It is quite common for a honeymoon phase to occur and for the damaged beta cells to work a bit – for a few weeks or a few months. This does not always happen, happens less with very young children and more with pre-teen and teenagers as well as young adults. It is more likely to happen if there is strict control of food and carbohydrates. There is some research that this produces a prolonged effect with fewer long term complications and better long term control if the beta cells can be induced to work for a longer period of time. If the hypoglycemia continues, then you keep adjusting the insulin downward and/or the food upwards accordingly.

SB