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April 23, 2000

Blood Tests and Insulin Injections

Question from Iowa, USA:

Do you feel that it is acceptable to take an insulin shot without testing? My son has type 1 diabetes, is 13 years old, was diagnosed approximately 3 1/2 years ago, and is now taking 5 shots per day. For his 3 A.M. shot he sometimes skips his sugar test and takes his shot. His mother has no problem with this and I am concerned that he may have a low blood sugar reaction to this one of these days.

Answer:

At first glance and without any understanding of the underlying rationale it seems a stiff price for a 13 year old to have to pay for good control to have to have 5 shots a day including one at 3:00 A.M. At the end of Chapter 1 in Dr Peter Chase’s Understanding Insulin-Dependent Diabetes which you can read or download at www.uchsc.edu/misc/diabetes/UIDDM.html, you can see a diagram of three alternative three shot a day insulin regimens which you might like to discuss with your son’s doctor. Another possibility, in order to avoid the 3:00 A.M. dilemma, would be to consider a pump. Your son would need to be looked after at the start by a team that had experience both with pump use and this age group. You would also need to know to what extent your insurance would bear the cost.

To answer the original question: it clearly depends on what kind of insulin is supposed to be given at 3:00 A.M. as to whether it is safe not to do a blood sugar. To give Regular or Humalog would be a mistake; but Ultralente could be safe: it is in fact very unusual indeed to give insulin routinely at this time.

DOB