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September 8, 2002

Daily Care

Question from a nurse in Normal, Illinois, USA:

Is there new information that would be a rationale for the following practice? For a blood sugar of 80 mg/dl [4.4 mmol/L] or less, take 2-3 units of Humalog insulin and two or three glucose tablets before lunch. Repeat as needed. Because of confidentiality issues I am not comfortable providing additional information about this child. Once I have current and accurate information I will be contacting the physician of record.

Answer:

I suppose that I could come up with a scenario that might require the addition of insulin plus glucose tablets just before lunch for a glucose of 80 mg/dl [4.4 mmol/L] or less, but it does seem odd.

If the glucose is 80 mg/dl [4.4 mmol/L] before lunch, then why eat “extra” glucose rather than add to the carbs at lunch? Does the child carb count? Does the family dose insulin based on carb consumption?

To give a better response, and without breaching confidentiality issues, one would need to know the child’s meal plan, activity schedule, etc. Too many questions/variables to answer your question optimally!

DS