My daughter was diagnosed with type 1 in August 2004. She has been on an insulin pump since May 2005 and has had good results with a decreased A1c. Recently, when school started, her lunch numbers became elevated. A two hour post check after breakfast showed a marked increased in blood sugar levels into the 200s mg/dl [11.1 to 16.6 mmol/l]. My diabetic educators would like this number to be no higher than 160 mg/dl [8.9 mmol/L]. After changing insulin to carbohydrate ratios to coverage her morning resistance and decreasing her basal in the morning, I have found that, if her two hour postprandial number is good, she experiences lows right before lunch. Her basal rate is as low as it can be on her pump. She is using Humalog. I have been told this is probably due to growth hormones. It seems as though her bolus is catching her later and causing her lows. It does not seem to matter what her blood sugars are in the morning, whether they are high or in her target range and no correction is needed. Have you seen this in children before? I feel that, if by lunch time (breakfast 8 a.m. lunch 12:30 p.m.) her numbers are good, this is acceptable

I’m actually uncertain of your question.

If you are looking for “reassurance,” then perhaps I can give you some because I sometimes feel that you have to “see the forest from the trees” and, in this case, if she has isolated, albeit recurrently predictable high readings, but her overall A1c is good, then I might accept matters for now.

Things that you might consider although is not just adjusting the insulin-to-carbohydrate ratio but the type of “bolus given.” Different pumps use a bit different terminology, but most routine meal boluses are given as a “spike” of insulin. But, some of the pumps have the capacity to give that same amount of “spike” but over a more prolonged time frame. This is sometimes called an extended bolus or square-wave bolus. Still other pumps allow you to give that same amount of insulin, initially as a partial “spike” and the remainder over a prolonged time. Talk with your diabetes team.

As an aside, I personally do not typically advocate the use of a pump in someone who had diabetes for only nine months, as I think the diabetes honeymoon often confounds matters and “tricks” families into thinking that they are doing far better than they are.

Having said that, pumping after nine months I think is better than pumping before six months. And, if you are followed by the Pediatric Endocrinology Department of the local children’s hospital in your city, you are followed by a premier group!

DS

[Editor’s comment: You may also want to read What is Insulin? to learn about peak times.

BH]