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August 24, 2017

Hyperglycemia and DKA, Meal Planning, Food and Diet

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Question from Phoenix, Arizona, USA:

My six-year-old granddaughter has had type 1 diabetes for a year and a half. She is following Dr. Bernstein’s low carbohydrate plan but still has blood sugars over 200 mg/dl [11.1 mmol/L] most of the time. Could she be insulin resistant? Are there any tests for her to have to see why insulin does not seem to bring her down?

Answer:

It seems like too little insulin. It could be related to types of insulin being provided or timing of insulin. Most pediatric diabetologists recommend a multidose insulin regimen with Lantus or Levemir as basal insulin and meal time (prandial) Humalog or Novolog to provide optimal delivery of insulin at meal times, allow for adaptations up and down for activity and carbohydrate choices, as well as individual variability from day to day. If that were not to work or there were too much variability, then consideration for an insulin pump would likely be the next step since this helps with adjustments while simultaneously minimizing random hypoglycemia. It would be important to talk to the diabetes team to learn their thoughts on the cause for persistent high sugars even on a low carbohydrate meal plan.

SB