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March 27, 2001

Daily Care

Question from Lindenhurst, New York, USA:

My five year old daughter was diagnosed with type�1 diabetes about nine months ago. She is on NPH and Regular at breakfast and NPH at bedtime. We give her Humalog according to a sliding scale, if her blood glucose level is 300 mg/dl [16.7 mmol/L] or over. On the whole, she is sticking to her plan, but she will on occasion eat a lot, and we try to compensate (especially at dinnertime) with more insulin. For the past week, she seems to have fallen into a pattern of starting out the day either low or in her target range, and then gradually increasing her blood sugar level throughout the day to over 400 mg/dl [22.3 mmol/L] at bedtime. Any suggestions? Should we talk to our endocrinologist about adjusting her sliding scale so we would give her insulin if she's over 200 mg/dl [11.1 mmol/L]? (Sometimes I think, if we did that, she wouldn't have ended up so high at the end of the day.) Are there certain types of foods that we should try to avoid?

Answer:

My first question would be to ask if your daughter is going low in the night and you are seeing the rise on the way up to very high levels later in the morning. Be sure of that first. You may also be seeing the end of the honeymoon after nine months of diabetes and her insulin needs have changed. Do see her doctor.

LD