October 7, 2000
Question from Saskatoon, Saskatchewan, Canada:
My 11 year old son has had type�1� diabetes for five years. His control is sub-optimal, with large variation depending on his activity, and many high sugars that may or may not be rebounds from unrecognized lows, as he feels fine with sugars of 2 mmol/L [36 mg/dl] and doesn’t wake with lows at night. Our local diabetes team is overwhelmed and can’t see kids more than every five to six months, which isn’t much help. Is there a resource you can suggest with specific information such as: How much insulin does a child, of a certain age and weight, need to lower his sugar by a certain amount? Also, aside from waking hourly every night to test his sugar, is there a practical way of telling how often he’s low at night?
I appreciate your concerns. I would suggest looking into the possibility of an insulin pump. This allows you to make many changes to achieve more successful control and fewer episodes of nighttime lows. In the meantime, there is a product (I’m not sure if it’s available in Canada) called NiteBite which helps prevent nighttime lows.
I wish there was a mathematical calculation that could accurately predict how much insulin a child or teen needs. Unfortunately, although there are some calculations that may be of some limited use, in the majority of cases, one’s insulin dose must be based on their insulin need which is determined by their response to various amounts and types of insulin. This is best done by an experienced physician on a diabetes team. I’m unsure of the resources available to you in Canada. Certainly, there are many places in the US that could help you, if you were interested in travelling to your southern neighbor.