My 8 year old son was diagnosed with type 1 diabetes at the age of 6. His blood sugar is under good control, with his HbA1c close to ‘normal’. We do blood sugar testing 6-8 times per day, 2 shots per day (7:30�A.M., 6�P.M.).

During the past few weeks it occurred on 3 occasions that he had a severe low blood sugar reaction shortly after the 6�P.M. insulin shot (a mix of Regular and NPH insulin). Within less than 5 minutes his blood sugar dropped from 150 mg/dl to below 30 mg/dl. We injected at different body parts, i.e., belly and thigh. Did we happen to inject directly in blood vessels this frequently?

I think you didn’t happen to inject insulin into your son’s blood vessels at all. In fact, with new shorter needles available nowadays it is quite rare.

The dramatic fall of blood sugar you describe occurring so rapidly (in less than five minutes) could imply the absorption of insulin from the injection site was too fast though. I’d try to ameliorate the situation trying either to avoid belly as the injection site for the dinner (favouring the thighs) as well as splitting the 6�P.M. dose leaving Regular before dinner and postponing the NPH at bedtime.

MS
Additional comments from Dr. John Schulga:

Also worth noting that if the diabetes control is run very tightly, the risk of hypoglycaemia is significantly increased, as demonstrated by the DCCT. It may be worth looking at how tight the control is and looking at ways you might be able to reduce the risks of further hypos.

JS