My 10 year old son, who was recently diagnosed and is taking twice daily NPH and Humalog, is very hungry and wants to eat more. I feel it is wrong to stop him from eating so I have been increasing the Humalog, but I am afraid this might be wrong. Will it make the medicine less effective if he takes too much? Am I doing something that will hurt him in the long run? His last A1c was 5.8% (before this increase in appetite).

In my practice, I encourage kid’s to have a well balanced diet. I don’t impose too many restrictions on kid’s diet other than recommending that simple sugars be avoided such as soda pop (with sugar), candy and other foods that have real sugar. Rather, I suggest that many of the sugar-free foods such as diet soda, sugar-free candy, sugar-free Jello etc. be used as an alternative when possible. I usually ask families to all participate in this strategy rather than singling out the one member of the family who has diabetes.

You are entirely correct to increase the amount of Humalog you are giving to cover extra amounts of food. Your son’s diabetes team should be able to help you find a formula (correct for your son) that helps you determine the amount of insulin for the food he is eating. A typical dose for Humalog in this case would be 1 unit for each 15 grams of carbohydrates. This general strategy is called carbohydrate counting.

If you need extra help with this, I would encourage you to talk to the a dietitian familiar with current treatment of type 1 diabetes in children.

MSB