February 14, 2003
Daily Care
Question from Newark, Delaware, USA:
My 18 year old daughter, who has had diabetes for eight years and had gastroparesis last year (which I think it is coming back since we can’t keep her blood sugars in a good range), is on an insulin pump, and for about a month, she as had a difficult time keeping her blood sugars in a good range. She really spikes after a meal (up to 400-500 mg/dl [22.2-27.8 mmol/L] sometimes. She tests a lot and hesitates to increase her bolus because if she waits until the complete bolus is out she usually is usually is a normal range. Her last A1c was 8.0%, and before that it was 7.0%.
We are testing her basal rates and all except the one that checks for dawn phenomenon have been tested and are okay. We are hoping once we can get the dawn rising in shape that things will level out. When she is high in the morning we can almost guarantee that she will be high most of the day.What can we do about the spiking?
Answer:
You should go back and discuss this in greater detail with your daughter’s diabetes team. It sounds like she may need a square wave instead of a standard bolus to try to control the postprandial hyperglycemia spikes. Sometimes, taking the insulin half an hour ahead of what you are doing will also help without having to increase the actual insulin dosage.
It would be reasonable to experiment and try using an alternative insulin analog (Humalog and NovoLog are both available) to see if one or the other might provide better postprandial coverage. If she can achieve better postprandial glycemic control, the hemoglobin A1c should come down and perhaps the gastroparesis will also improve with better glycemic control.
SB
