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January 22, 2002

Daily Care

Question from San Pedro, California, USA:

I think my five year old daughter, diagnosed with type 1 diabetes about three months ago, is still in the honeymoon phase, but sometimes she will have a high reading (230-304 mg/dl [12.8-16.9 mmol/L]) which is sporadic. Is this common? I called her doctor who said not to change her insulin intake unless the high readings continue for at least four days in a row, and I'm not sure what to do.

Answer:

You should maintain your on-going dialogue with your daughter’s doctor.”Sporadic” high glucose readings do not concern me, generally, unless they are associated with moderate to large ketones in the urine, in which case some extra short-acting insulin right then may be warranted. The honeymoon phase is variable and underscores the importance of watching the glucose readings, remembering to check for ketones if the glucose value is greater than 240 mg/dl [13.3 mmol/L]. If you saw a pattern of higher (or lower) readings (e.g. more often higher at specific times of the day), then your doctors would likely want to consider a change in the usual daily doses.

DS
Additional comments from Dr. Stuart Brink:

Isolated high values usually mean you’ve made an error in estimating effects of food and/or activity — and should have provided more insulin. During the honeymoon phase, pancreas is working better but still not perfect so this is not uncommon. If you are keeping good logbooks, you should be able to understand such changes in blood glucose readings more than 90% of the time. If you do not or cannot do this, then you probably need to work with your diabetes team to get more education so that you’ll get better. But no reason to panic as long as they are only intermittently high and come back down quickly.

SB
Additional comments from Dr. Larry Deeb:

I would agree for now. If you have “correcting” formula for using rapid-acting insulin, this I would use it.

LD
Additional comments from Dr. John Schulga:

It can be very difficult to maintain stable glucose readings in a five year old child, as life is not always very predictable when you are five. I would agree that it is the pattern of glucose readings that is important rather than trying to deal with individual readings. Otherwise, you will start to find great difficulties because you will be chasing your tail, often with readings that will probably fluctuate even more. It is best to try and sit tight and see what the trend is.

JS