My 10-year-old daughter has been diagnosed with diabetes and has been in the hospital for seven days. Although she is getting insulin, her blood sugar levels are still high, sometimes between 20 mmol/L [360 mg/dl] and 25 mmol/L [450mg/dl]. Our doctor has not referred us to a dietitian yet and says he is not worried about her sugar level until she has put on some weight. My daughter lost 12 kgs (26 pounds) in two weeks due to what we thought was a virus. We are very concerned, especially as the books we read say the longer the blood sugar is high, the higher the risk it is to our daughter. So, should she have been referred to a dietitian to help her put on weight and keep her sugar levels down?

I presume that this 10-year-old girl indeed has type 1 diabetes. Management of diabetes hinges primarily on three equally important issues: insulin administration, diet, and exercise.

I don’t know just how sick your daughter has been, but a seven day hospitalization seems a bit long to me these days to teach YOU and HER how to draw up and give insulin, check glucose, learn to check urine for ketones, learn about food choices, etc.

It may not be so uncommon to still have some persistently high glucose readings during this first week, but the levels should come down, especially if the insulin doses are adequate and the meals are appropriate. With her 12 kg weight loss before diagnosis, I would expect your daughter to have a ravenous appetite with rapid weight gain to “catch-up”, assuming she is getting adequate insulin.

In very general terms, I would expect her TOTAL DAILY insulin requirement to be approximately one unit for every kg that she weighs. So, if she weighs 30 kg, she should take about 30 units total. Does she weigh 30 kg now (but was 42 because she lost 12)? She might require closer to 40 or more units initially. Then, we would expect, over the next two to six weeks, for her to enter her “diabetes honeymoon” phase and the insulin requirements will decrease and her glucose levels would be expected to lower.

So, your daughter does need to see a dietitian, not so much to “gain weight” — as blood glucose regulation should accomplish that, but to learn to make best food choices and count the calories and carbohydrates, etc.

I don’t know the resources available to you overseas, but you and your doctor might want some input from a pediatric endocrinologist and a Certified Diabetes Educator, who is usually a Registered Nurse but sometimes also a Registered Dietitian.

DS