February 9, 2004
Insulin
Question from Greensboro, North Carolina, USA:
My 17 month old son was diagnosed with type 1 a month ago. He is currently on two injections of Humalog and NPH a day. He is a very active toddler who, at his current age, we do not believe would do well on the pump. At what age are you seeing most children go successfully on the pump? We originally started on Lantus and Humalog and they switched his Lantus to the NPH without giving the Lantus much of a chance. Do you believe that Lantus provides the best control? I stay at home with my son and give his shots. I dread having him on four shots a day, but am willing to if it would provide him better control.
Also, what is the target blood sugar for two hours after a meal for a toddler? Our doctor would like his target pre-meal blood sugars to be between 100-200mg/dl [5.6-11.1 mmol/L], however, we have been finding that his blood sugars are often in the 300s two hours after he eats and the doctor suggests that this is okay and wonders why we check them two hours after he eats. My husband is type 1 as well and we are very consistent with checking blood sugars. Is it true that children do not need to maintain tight control? I worry with these high blood sugar readings.
Answer:
I would start by working with your diabetes team to get your son on carbohydrate-insulin ratios with corrective doses for Humalog for his two shots per day. This will allow you greater flexibility in allowing him to eat or not eat as he pleases and then will open you up to considering other insulin options, which might involve more shots. If you end up doing multiple shots each day with a short acting insulin, and will be rounding to 1/2 units, I’d consider looking into the NovoLog Jr. pens which allow for dialing in 1/2 unit dosings. You can’t “mix” insulins in these pens, but the pens have very small needles and can be very convenient at times when you’re just giving one type of insulin.
LAD
