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October 23, 2009

Daily Care

Question from Dalby, Queensland, Australia:

My two-year-old son was diagnosed six months ago with type 1 diabetes. It is really a great struggle to get his blood sugars levels stabilized. He is currently on Actrapid and Levemir before breakfast, NovoRapid before Lunch and Dinner. Over the past two months, we had only three days that his sugar levels were between 5 and 15 mmol/L [90 and 270 mg/dl]. The other days, he has at least one or two lows and one or two readings between 15 and 25 mmol/L [270 and 450 mg/dl]. It is killing us to not getting him stable and we are worried about permanent damage to his little body. He is on a very strictly controlled diet. His diabetic team is good, but guesses a lot on what to do - to our frustration. Can someone out there relate with this? Do you have any advice?

Answer:

Diabetes in two-year-old is difficult. Most of our patients use an insulin pump because of these variables in food, activity and even insulin action. The regimen you are using is quite reasonable but most of our patients use Levemir twice-a-day to get small amounts overlapping long acting insulin if they are not using a pump. Also, it would be very important to be sure that the fast acting analog is given 15 minutes ahead of food, if possible, since that allows the insulin and food peaks to coincide better, decrease postprandial hyperglycemia and also decrease the late hypoglycemia at the third and fifth hours after the injections of the analog. Of course, this is not always possible in a toddler but still should be a general goal. You may want to go to our Chat Rooms to talk with other parents of toddlers in Australia and around the world. This is often very helpful as well.

SB