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October 21, 2004

Blood Tests and Insulin Injections, Honeymoon

Question from Greece:

I am 15.5 years old and was diagnosed with type 1 diabetes eight months ago. My blood glucose levels don't tend to be very high and I am in my target range most of the time. My doctor suggested that I keep my blood sugar 80 to 120 mg/dl [4.4 to 6.7 mmol/L] before meals and less than 140 mg/dl [7.8 mmol/L] two hours afterwards, but I have set my target to the normal range. I know that this can cause me to go low more often, but I think that it has given me much better results and the fact that I test eight to 10 times a day allows me to have better control. Do I have to insist on this? I am on three injections per day, Mixtard 40 and Regular. I have noticed that, for a few days, I need to lower my insulin dose more and more and then, one day, they start to be more high and I then need to increase my dose very much in contrast with my previous one. For example, I needed six units of Regular for lunch, then later it increased to 22 units. What can cause this? I am not overweight. My Body Mass Index (BMI) is 19.2. I always measure what I eat, follow my diet and exercise. I think that maybe I need to change the types of insulin I need. What is your opinion? I want to have the best control over my diabetes. I try to gather as much information about diabetes as possible in order to make the best choices and have managed, until now, to keep my A1c in the normal range. My last A1c was 5.4%.

Answer:

You probably are in the so-called honeymoon period during which it is easier to keep a good glycemic control. You are so smart to check your blood sugar levels so many times a day. Surely, this is the best to do in order to keep a good control. Just one thing; it could be that after some time, you can get tired of all these checking. So, it could be wiser to slow down a little (I think a check before each meal and before going to sleep is sufficient). In any case, you can discuss this with your diabetes team.

AS