My son, who is almost ten years old, was diagnosed with type 1 diabetes just over two years ago. We recently moved and had to change to a different endocrinologist. His previous routine was NovoLog at meals, Lantus at bedtime, and three 15 gram carbohydrate snacks a day. His new doctor said to give NovoLog every time he eats, including snacks. I understand the reasoning, but it’s hard for my son to be told he has to start having more injections. So far, he’s avoided it by eating low carbohydrate snacks which is fine and, honestly, it seems like his glucose readings have improved in three days.

We previously had to follow a two hour rule. No food two hours after a NovoLog injection. Now, it isn’t supposed to matter. I would just like your opinion on the different regimens.

I tend to agree with your new endocrinologist, but I think both approaches are reasonable. I believe that you have to dovetail the insulin administration to fit the meals and the meals (and activities) define the lifestyle.

Both your previous and current endocrinologists required you and your son to have some specific discipline: before, he was limited in the amount and the frequency of food –and I presume his glucose levels were okay. Now, he has been given some flexibility in meal and snacks, but the trade off is the discipline in providing insulin every time he eats at least 15 grams of carbohydrates.

I think the second approach reflects real life more. If “extra shots” is some type of hurdle, it may be now time to think about an insulin pump. If he can consume lower carbohydrate snacks, then great for him!

DS