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April 7, 2003

Daily Care

Question from Wilmington North Carolina, USA:

At dinnertime (6:00 pm), I give my seven year old daughter 8 units of NPH with 1 unit of Humalog no matter what her numbers are, and she eats 40-60 grams of carbohydrate. Two hours later, her blood sugar is 60-120 mg/dl [3.3-5.7 mmol/L], she eats 30 more grams of carbohydrate. Before bedtime (about an hour later) she is 90-120 mg/dl [5-5.7 mmol/L]. I give her additional 25 grams of carbohydrate, and she usually wakes up at 70-140 mg/dl [3.9-7.8 mmol/L]. She really does not want to eat this much at of bedtime. Would you suggest cutting back on the NPH or Humalog? If I check her after two hours, she is 60-120 mg/dl [3.3-5.7 mmol/L], and eats 30 grams, how long does it take this to affect her blood sugar?


Adjusting insulin dosing is an important task to achieve good control of diabetes. That is not a task that is best accomplished by our Diabetes Team on-line. It is best done by looking at insulin dosing, carbohydrate intake, activity, and other “patient specific” items. Your daughter’s physician or diabetes educator is the best resource to accomplishing this. I would suggest you collect all of the above information and spend a few minutes reviewing it with your educator who can help you make the changes you’re looking for.

I would also suggest that you avoid feeding your daughter unless she is hungry. Kids that have established “must have” meals or snacks are at risk for putting on too much weight. Your daughter’s diabetes care plan should be flexible enough to allow your daughter to skip a meal or snack if she is not hungry. Also, the old idea that “you must have a bedtime snack” has fallen out of favor in the past few years. If your daughter is having lows at night because of not having a snack, then I would suggest changing her insulin dosing — not forcing snacks.

Paying close attention to this is so very important. I’m pleased that you’re obviously thinking about the details of your daughter’s diabetes management! Good luck!