March 2, 2010
Daily Care, Hypoglycemia
Question from Ann Arbor, Michigan, USA:
Our 10-year-old daughter was diagnosed with type 1 18 months ago. We thought she had come out of honeymoon when her insulin needs almost doubled after six months and have not changed. For the last couple of days, strange things have been happening. One hour after lunch, she goes low (50 to 70 mg/dl [2.8 to 3.9 mmol/L]), coming up only after we treat her with about 100 grams worth of sugar and turning off her pump for four hours. This has never happened before. She eventually goes up and we put her pump back on. Has anyone experienced this? We spoke to the nurse and she asked us to decrease her lunch bolus, but I am concerned that she does not seem to need basal insulin either. How would a decreased lunch bolus help?
I think your nurse is quite right about reducing meal boluses. Nevertheless, even a small change in the meal boluses makes a difference in terms of postprandial spikes and then keeps helping whilst fasting blood sugar is regulated by basal insulin at most. Remember that it’s the A1c that counts and you must continue to work on maintaining in range blood sugars.