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April 18, 2007

Daily Care, Insulin

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Question from San Diego, California, USA:

At bedtime, my five-year-old daughter’s blood sugar is 317 mg/dl [17.6 mmol/L]. By 1 a.m., she will be around 180 mg/dl [10.0 mmol/L] or 214 mg/dl [11.9 mmol/L]. Is this normal? In the past, we gave her Lantus, NovoLog and NPH, but we stopped the Lantus and NovoLog because of low blood sugars. Then, I was giving her two units of NPH in the morning. Her lunchtime blood sugars were 45 mg/dl [2.5 mmol/L], 56 mg/dl [3.1 mmol/L] or 68 mg/dl [3.8 mmol/L]. Her fasting blood sugars have been 90 mg/dl [5.0 mmol/L], 130 mg/dl [7.2 mmol/L], 150 mg/dl [8.3 mmol/L], 180 mg/dl [10.0 mmol/L], 170 mg/dl [9.4 mmol/L], 200 mg/dl [11.1 mmol/L], and 280 mg/dl [15.6 mmol/L].

Answer:

There are too many questions here that I cannot answer best because we don’t know more specifics about your daughter. You should keep a dialogue with your daughter’s own pediatric endocrinologist. There are several excellent ones in the city where you live and if you find that you are not satisfied, you should certainly seek out a second opinion.

While many would agree that bedtime glucose levels can be up a little bit, I think the 8 p.m. and 1 a.m. glucose values that you report are too high.

DS