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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.


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.