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November 16, 1999

Meal Planning, Food and Diet

Question from Overland Park, Kansas, USA:

My 22 month old daughter was diagnosed with type 1 diabetes about 5 months ago. We currently are giving 2 injections per day of NPH and Regular. I am very concerned about the eating habits we are establishing in our effort to avoid lows. We consistently offer 3 carb meals and 1 carb snacks but like most toddlers, she doesn't always all (or any for that matter) of what we give her. I am finding myself bribing, chasing, and tricking her to get her to eat. We sometimes resort to a little chocolate milk powder in whole milk to make up for a missed or skimpy meal. I have 2 other daughters and have always believed in trying everything but eating only what you need to feel satisfied. I've talked to my daughters endocrinology team and they say the doctor does not recommend intensive insulin therapy in patients this age. Can you give me some pros and cons about different types of insulin therapy?

Answer:

We also would not recommend intensive therapy, but here are a couple of ideas:

See if you can switch the Regular insulin to Humalog and then give the insulin after a meal so you can see what has been eaten. The Humalog covers the meal, so only whatever carbohydrate is eaten needs coverage.

Offer juice to cover the missed carbohydrate — it is not so much of a reward as a replacement and juices certainly contain vitamins. We have found the Hershey’s syrup is like Hershey’s candy, a previously forbidden sweet that you can get as a reward when you do not eat your foods. (So why eat your regular meals?)

LSF

[Editor’s comment: See Conventional Versus Intensive Diabetes Therapy in Children with Type 1 Diabetes for information on why intensive therapy in young kids is not recommended.

JSH]