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December 15, 1999

Meal Planning, Food and Diet

Question from North Carolina, USA:

My 19 month old grandson was diagnosed with Juvenile (Type 1) Diabetes 7 months ago. He gets an injection each morning of 1 1/2 units of Regular insulin and 2 1/2 units of Ultralente. His doctor wants his blood sugar to stay between 200 and 225. It seems like everything he eats raises his blood sugar to way above normal. It is not unusual for it to be in the 400's 2 or 3 times a day. He is very picky but loves to eat and finding the right foods to give him that won't raise his blood sugar or when his blood sugar is high is next to impossible. My daughter-in-law does not give him any additional insulin until approximately 8 hours after his morning dosage (Regular lasting 4 hours and the Ultra kicking in after that). The doctor has given her a guide to go by listing the dosages to give him when it's high, but during this 8 hours she doesn't use it. Do you have any suggestions? Can he be given Humalog during this 8 hour period? Also, he has a problem with constipation. He won't eat fresh fruit, so what can we do?

Answer:

I would recommend that a young child receive care from a diabetes team that has experience in taking care of young children with diabetes, even if it means a long drive.

The care of the young child with diabetes is complex and individual. We wouldn’t be able to assess your grandchild’s routine here, but perhaps you could read a book such as Diabetes Care for Babies, Toddlers, and Preschoolers: A Reassuring Guide by Jean Betschart,�CRNP,�CDE. If you are able to attend appointments to learn about the care of your grandchild, this would let you ask questions of the people that know your grandchild best.

Although you may receive goals for blood sugars, the numbers will vary. And yes, after eating the blood sugar does go up. Most clinicians would recommend avoiding frequent or severe hypoglycemia, if possible, in young children with diabetes. Therefore, your grandchild’s individual blood sugar goals are likely to be higher than for an older child.

LM