My 5-year-old daughter wears an insulin pump and uses NovoLog. She consistently has a high (over 300 mg/dl [16.7 mmol/l]) blood sugar one hour after breakfast as well as a high blood sugar (over 200 mg/dl [11.1 mmol/l]) two hours after breakfast. I have tried a higher insulin carb ratios to get a good 2 hour number, but when I do, she has a low number by lunch (50 or 60 mg/dl [2.8 or 3.3 mmol/l]). I have basal tested this period many times, it is good. I have also tried a combination bolus, two different way – 66% now, 34% over 1 hour and 75% now, 25% over 1 hour. Neither worked. The rest of the day, I have no problems. I would just like to be able to get a good post prandial number without risking a serious low 3-4 hours later.

In most kids this age, the carb/insulin ratio sometimes covers part of the “basal” requirements, because the insulin takes longer than 2 hours to peak and be done. To get a lower 2 hour number, you might want to try one of the following:

Give a bit of the anticipated carb/insulin ratio 15-20 minutes prior to starting the meal, giving the insulin time to kick in before starting to eat, or

Go ahead and increase the carb/insulin ratio in the morning and then decrease the basal rate over that time period. I know it’s not a technically “correct” approach (and that the basal will then pull your daughter low by lunchtime if your child does not eat), but it works in practice as long as she has some breakfast.

We usually look at “post-prandial” numbers being at least 3 hours after eating (rather than 2 hours) in children of this young age on pumps.

LAD