March 28, 2001
Daily Care
Question from Seattle, Washington, USA:
My 11 year old daughter, diagnosed with type 1 diabetes about eight months ago, is still in the honeymoon phase and has a hemoglobin A1c of 5.8%. She receives NPH and Humalog insulin twice a day. Her bedtime reading may be 100 mg/dl [5.6 mmol/L], but an hour after her snack, she may be between 70 and 80 mg/dl [3.9 and 4.4 mmol/L] or lower. Why is she so low when she just had a snack and was higher earlier? Our endocrinologist is stumped because the Humalog should have worn off and the NPH is just starting. They want her to be at least 100 mg/dl [5.6 mmol/L] before bed. We would appreciate any ideas you may have.
Answer:
It seems pretty clear that the combination of Humalog and NPH is having a pretty good effect and there appears to be an overlap in the action of the two. I would agree about the number for bedtime which is less of a concern because of the honeymoon and little insulin, but real. Does she get lower in the early morning? Maybe she does need the NPH at bedtime.
LD
