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March 12, 2006

Daily Care

Question from Page, Arizona, USA:

My grandson's doctor is having my daughter feed my grandson whatever he wants. He says this is okay as long as she counts the carbohydrates before he eat and doses his insulin accordingly. She is having to inject him five to ten times a day and his blood sugar numbers are usually quite high, 200 to 500 mg/dl [11.1 to 27.8 mmol/L]. This method doesn't sound right to me. I am a diabetic and I have been told to watch what I eat, counting sugar and carbohydrates. I am currently using Lantus and take metformin twice a day. Is there this big a difference in the way children are treated?


Children usually have autoimmune type 1 diabetes with virtually no insulin being produced. Adults usually, but not always, have type 2 diabetes with insulin resistance. Some go on to need insulin eventually and, so, would use what you are using, a combination of an oral agent plus insulin. However, if your grandson’s blood glucose levels are always so high, then his control is, by definition, poor and he is at risk for short and long term diabetes related complications. The actual number of injections needed for any individual is highly variable and the system that you describe, carbohydrate counting, provides more flexibility as long as it is applied correctly. By definition, with such frequent high sugars, either the carbohydrate counting is not done correctly or the insulin algorithms being utilized are incorrect. So, I would ask the diabetes team what suggestions that they have for improving the blood glucose results and see what else might be considered: different algorithms, higher insulin to carbohydrate ratios, different correction factors, insulin pumps, different basal insulins (i.e., Lantus rather than NPH, split Lantus rather than single dose Lantus, etc.), etc.