My 10 year old son, diagnosed with type 1 diabetes at age four, is on Humalog three times a day and NPH twice, but we have never been able to get him regulated; he still has highs and lows. We feel his diet is good, and he seems healthy, happy and is active. However, his doctor thinks he could be better controlled. His average blood sugar for the last 30 days is 10.75 mmol/L [194 mg/dl]. Can you comment on these readings and perhaps suggest what we may be doing wrong and ways we could improve?

I can understand your troubles and your concern about your son. Controlling blood sugar levels in a ten year old is a tough challenge and takes some time depending on the partners (the patient with his/her family and the diabetes team). I think you should try harder and sooner to get better metabolic control as is best judged by your son’s hemoglobin A1c).

To achieve this nowadays, the best therapeutic approach would be any basal/bolus insulin. Quite recently, insulin pump therapy has spread among youngsters, but your family would need to have very close contact with a diabetes center comfortable in using the pump with children and adolescents.

Nevertheless, education is, by far, the most important thing in achieving good metabolic control, and it seems you might need some more. It’s not the professionals on your child’s diabetes team who should manage diabetes; it’s the patient with his/her family who must be educated on how to best manage it. To this aim, our website can make the difference through its easy and fast access to news and information regarding diabetes and its management. It can help you keep up-to-date through our answers to various questions and topics.

As your son grows up, he will be gradually able to take more responsibility with self-monitoring and self-management. This will be helpful for better metabolic control. In the meantime, trying to avoid frank hypoglycemia and huge fluctuations of blood sugar levels as very temporary goals.

Last but not least, soon there will be new devices and therapeutic opportunities that will make the lives of children with diabetes easier and safer.

MS

[Editor’s comment: It might be worthwhile for you to stop “chasing” blood sugars with Humalog for a while so you can see developing patterns over a few days and then respond with the appropriate insulin. Remember that the blood sugar you are looking at reflects the action of the preceding insulin dose, and not the one you are about to give. Constantly chasing the highs often leads to a yo-yo effect and makes it virtually impossible to see a clear picture.

I think you will find the book, Stop the Rollercoaster by John Walsh and Pat Roberts, to be extremely helpful.

SS]