My 10 year old daughter, who has had diabetes for about six years, was on NPH with a sliding scale of Regular (which worked well) up until two weeks ago when she saw a new doctor (who mostly deals with adults) and was changed to Humalog and Ultralente. Her levels now have been between 230-500 mg/dl [12.8-27.8 mmol/L] with a few lows. This doctor gave us no diet plan and I am concerned ! What do you suggest I do?

The rationale to switch insulin plans for your daughter was probably two-fold:

To give her a more physiologic way of receiving insulin (presuming that you dose the Humalog based on carbohydrate counting, thus allowing her more flexibility in meal and activity planning.
To ease the transition for a possible switch to an insulin pump in the future.

However, if you were comfortable in her previous regimen and her hemoglobin A1c levels were good, then perhaps she didn’t need a change for medical reasons — only the supposition above.

No meal plan? What had you been doing before? That is probably compatible with the new regimen, but you should be carb counting, in my opinion.

The answer to your question as to what I suggest you do: talk with the new physician and convey your concerns and be comfortable with the plan. If you are not, then please seek the opinion of a pediatric diabetes team, if possible.

DS