August 25, 1999
Daily Care
Question from St. Marys, Ohio, USA:
I’ve been reading many of the previously asked questions recently to understand why my daughter’s readings fluctuate so much. She is 10 years old and was diagnosed 3 1/2 years ago. She is 55 1/2″ tall and weighs 81 pounds. She tests her sugar 4 times a day. She takes 13 NPH in the A.M. and 14 NPH in the P.M. (supper time). If she is over 150 at any testing time, she takes R on a sliding scale.
I just read that a sliding scale shouldn’t be used routinely (can cause fluctuations) and am wondering why, after 3 1/2 years, we are still using it. Her last A1c test was 8.4 which has been her highest. I am concerned and frustrated because she is very responsible with her testing and eating and yet she will be 70 one day in the A.M. and 300 the next. She can fluctuate like this at any of her readings which makes it difficult to determine when to adjust snacks or insulin.
We tried eating the exact same food for breakfast and A.M. snack (with the same activity level at school) and her pre-meal level jumped around like crazy (54,170,320,88 etc.). We were dealing with belly problems (reflux) for a while, which the doctor said explained her consistently high readings (300-400) especially in A.M. and P.M. and he is happy now that her highs lately have only been in upper 200s with a few in lower 300s. What is going on?
Answer:
I do prefer an insulin schedule that allows for “management” of the actual glucose and the planned meal (carbs). That means giving a different dose of insulin (short acting) before meals, based on meal size. This should be at least breakfast and dinner. I also wonder if the evening NPH shouldn’t be at bedtime.
You are a witness to the vagaries of insulin absorption. Same food and different responses. NPH may be worse than shorter-acting insulins. Have you thought about lispro insulin (Humalog)?
LD
Additional comments from Dr. Quick:
There’s nothing in your question to indicate whether your daughter’s doctor is a pediatric endocrinologist. If he is, show him this correspondence. If he’s not, ask for a referral to a pediatric diabetes team.
WWQ
