January 5, 2004
Daily Care, Insulin
Question from Tuscaloosa, Alabama, USA:
My 11 year old son has had type 1 diabetes for three years. About three months ago, he was switched to a protocol of Lantus (15mg) h.s. and NovoLog bolus at meal time. We count carbs and give him a sliding scale of 1.5 units/carb plus correction as needed. Recently we have seen a pattern as follows: He is low normal in the A.M. (60-80 mg/dl [3.3-4.4 mmol/L]). Two hours later he will be high (over 300 mg/dl [16.7 mmol/L]). We bolus appropriately and usually he comes down by supper. At bedtime he is high again (300+) and he gets his Lantus but no snack. He then drops down during the night. Early on the Lantus was great and his last A1C 1 month ago was 6.8. Since that visit though we have entered this cycle for some reason. We have replaced insulin vials and rotate sites. He weighs about 80 pounds. Any advice on the very high post-prandial blood sugar?
Answer:
Sounds like he needs higher bolus doses of Humalog than what you are using. He may also need a small amount of Lantus with the breakfast Humalog if his Lantus is not lasting a full 24 hours – in our practice, this is commonly the case with younger patients. Go back and discuss with your diabetes team.
SB
