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January 15, 2000

Hyperglycemia and DKA

Question from Temecula, California, USA:

My 9 year old daughter was diagnosed 9 months ago with type 1. I have heard something about not bringing the "high's" down too rapidly, but I can't remember why. Can you explain that? Her insulin needs are changing a great deal. In the past week, her dinner dosage has increased from.5 to 2.0 Humalog. Yesterday her predinner number was 373, and since 2 units did not cover the previous night's dinner (which also happened to be in the 300's), I increased her dosage to 3.0 units. Since I had never given her that much Humalog at once before, I rechecked her sugar one hour later instead of the usual 2 hours later, and found that she was 98. I fed her another 2 servings of carb since she still had Humalog working, but I am concerned at the rate she dropped. I was surprised that she was so low (both nights dinners had equal amounts of carb servings), and thankful that I had re-checked early since she clearly could not have sustained another hour of dropping at that rate.

Answer:

The problems with blood sugar dropping rapidly really seem to occur more when they fall from extremely high levels. A rate of fall of about 100 mg/dl/hr is reasonable.

It is not unusual for insulin requirements to fluctuate a lot during the first year or two after diagnosis. I would caution you not to start “chasing” blood sugars. Sometimes they can be high for a day or two for a variety of reasons such as impending illness and stress. Additionally, if your daughter’s Humalog has been opened for more than a month, it may be losing its effectiveness. Insulin vials should be changed monthly.

SS