Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
November 1, 2000
Question from the United Arab Emirates:
My 11 year old daughter was diagnosed with type 1 diabetes six months ago. We've been doing pretty well up until now, and her blood glucose levels were between 4-7mmol/L [72-126 mg/dl]. This was the normal range that I was asked to keep her in, although, below a 5 mmol/L [90 mg/dl] reading, she seems to experience shaking and feelings of being strange. Recently, her levels are above the 7 mmol/L [126 mg/dl] but below 10 mmol/L [180 mg/dl], according to the time of day. It seems that she rises more after 11 pm and can sometimes reach 13 mmol/L [234 mg/dl]. She has NPH 15 units (am) and 10 units (pm). I have been told to follow a three-day plan to determine whether or not the NPH should be increased or decreased. Humalog is administered with breakfast and dinner according to carbohydrate counting. Presently, she's at taking 1 unit of Humalog per 15 grams of carb. I appreciate your help as I have no confidence in the doctor at the moment, and I'm searching for someone with diabetes knowledge. Is there a specific safe amount of NPH according to the body weight and age of a child? What is the best range of blood glucose level to keep a child at?
Normal insulin requirements are of the order of 0.8 to 1.0 units/kilogram of body weight per day. In some instances, this can be exceeded, especially during puberty. The ratio of NPH to Regular is rather arbitrary to begin with, but, usually, 3:1 or 4:1. It changes with individual experience, but the aim is for the long-acting insulin to cover basal needs and for the short-acting to control after-meal peaks.
To begin with, you should aim to keep blood glucose levels between 4-10 mmol/L [70-180 mg/dl], but, with experience, and especially if you move to an insulin pump, 4-8.3 mmol/L [70-150 mg/dl] should be achievable. The shakiness that your daughter complains of below 5 mmol/L [90 mg/dl] is almost certainly due to hypoglycemia which has just been as low as 2.4 mmol/L [40mg/dl], but the body has compensated by the time you got to measure the blood sugar.
Using the above guides, you will need to discuss with your daughter’s doctor, whether changes are needed in the short- or long-acting insulin doses. In the case of Humalog, it is sometimes helpful to give this just after the meal so that you can adjust the dose to the pre-meal blood sugar and appetite. There is nothing wrong in, initially, judging the Humalog dose on the basis of the number of carbs, but this can vary, so that it is important to consider the other factors.
Nowadays, when the aim is for the best possible control without hypoglycemia, you need supplementary information. The first is to develop and maintain at least a rough profile of blood sugars throughout out the 24 hours so that you can get an idea of the effects of exercise, change in diet and stress on the pattern. The second is to have, if possible, quarterly Hemoglobin A1c tests which give a very good idea of the overall level of control. The aim is to be less than 1% above the upper level of normal. This may involve doing, at least for a time, rather more blood sugars. You both may find this much easier if you can get a FreeStyle meter sent to you.
Finally, I think that you would be helped by one of a number of manuals that you can find listed at this website, many of which can be obtained quickly from www.amazon.com.