My daughter and I just met with a specialist that comes to our area from the University of North Carolina. This is our second time seeing him. Both times we have waited three hours to see the specialist. He has recommended checking every two hours. We now check four to six times daily. The doctor thinks we are doing a great job, 7.6 A1c, but would like to fine tune. I feel that checking at 10 a.m. indicates how the short-acting insulin is working. After school checking at 3 p.m. indicates how the NPH is working through lunch. Checking at 6 p.m. indicates overall effectiveness. We check again at 8 p.m. and at 10 p.m., if necessary. Couldn’t the physician fine tune with the way we are checking now? Is the every two hours necessary? Your opinion is appreciated.

Well, it is hard to say because you really did not tell me exactly which other insulin your daughter is taking, besides the NPH, when you give it, what the meal/snack program is, etc.

In general, if you are giving NPH and Regular insulin 30 minutes before breakfast, and Regular insulin before the evening meal, and NPH at the evening meal (or at bedtime), then checking before meals and bedtime may be adequate in my mind. Sure, if you need to fine-tune, more frequent checks are necessary.

If you are giving Humalog or NovoLog as the fast-acting insulin before breakfast and dinner, then checking two hours after meals may be very appropriate because those insulins peak about 90 minutes after a meal. Regular peaks about 2-4 hours after a meal.

There is a reason that you see a specialist. But, there is no single “right way” to manage diabetes. Unfortunately, this is not a specialty with lots of practitioners so we are in short supply. I am in your neighboring state just South of you; I am the only peds endo at the Univerisity and only one of five practicing in the state. But, you do see a specialist and you have to wait to see them. So use your priviledge and call and talk with them about other options and flexibility for you.

DS