My six and a half-year-old daughter was diagnosed with type 1 diabetes four years ago. This whole week, her blood sugar has been high at lunch. For example, yesterday, she was 360 mg/dl [20.0 mmol/L] and today, she was 370 mg/dl [20.5 mmol/L]. She is on Humalog and Humulin in the morning. The Humalog is a sliding scale and the Humulin is seven units. Today, she was 130 mg/dl [7.2 mmol/L] at breakfast although, last night, at 3:00 a.m., she did drop to 48 mg/dl [2.7 mmol/L] so I gave her two glucose tablets. She has a snack at school, which I pack. I am wondering if she could be dropping low and then rebounding. I raised her Humalog yesterday and, today, she is still really high at lunch. Do you have any suggestions? I plan on testing her Saturday, when she is at home, at snack time to get an idea of what is happening.

From what you have written, I am not convinced these are “rebound” hyperglycemias. Ongoing and frequent testing should help.

What “Humulin” is she on? I presume you REALLY mean that she is on NPH insulin. I wonder if the dose, or the timing of the dose(s), may need to be adjusted. Do you count carbohydrates? Do you dose the Humalog based on the carbohydrate intake? What is the snacking schedule? What is the activity schedule? How old is the insulin? There are too many variables to best answer your question.

DS

[Editor’s comment: You may wish to discuss other insulin regimens with your daughter’s diabetes team. The Humalog you are giving should cover her breakfast, with the NPH covering her lunch. Although you did not indicate the specific times you administer the pre-breakfast shot and when she eats a snack, it could be that the duration of the Humalog has ended or almost ended and the NPH has not started working that soon. A shot of Regular could cover the morning snack. There are other options, as well.

BH]