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November 25, 2002

Blood Tests and Insulin Injections, Insulin Pumps

Question from Milpitas, California, USA:

My four year old son, diagnosed with type 1 diabetes two months ago, is receiving only 1 unit of NPH per day, and the doctor had said we could stop the insulin, but we thought it would be hard for my son to start receiving the shots all over again when the honeymoon ends. He weighs 43 pounds, is 43 inches tall, and I would like to put him on the pump because I sometimes feel I am feeding his insulin. He has never been a big eater, and I feel like I am forcing him to eat to prevent him from having lows. His dinner numbers are starting to rise, so they have asked us to increase his NPH to 1.5 units tomorrow. Do you think the pump is a good idea even though he is in his honeymoon phase? Is it wise to wait until the honeymoon is over to start the pump? Do you think he should have a C-peptide test done? He has never had one.

Answer:

I think that you were right not to stop the insulin despite the present more or less token dose of about 0.05 units per kilogram of body weight per day. At the same time, I think that you should check with the doctor whether your small son had a positive antibody test to make sure that he does indeed have type 1A (autoimmune) diabetes. If he does (and it is by far the most common form in new onset Caucasian children in the US), then he is going to require some sort of insulin supplementation for the rest of his life and his present minimal needs would be typical for the honeymoon period.

His BMI (Body Mass Index) was only about 17 despite his being around the 90th percentile for height and weight, so that I don’t really think he is going to need a C-peptide test to rule out type 2 diabetes.He is clearly though quite big for his age so that I don’t think that there is a need to try to make him eat more than he wants, rather it would be better to go a little slower with the increase in insulin dose to avoid hypoglycemia.

As to starting him on a insulin pump, I would personally wait until the diagnosis is confirmed and the daily insulin dose has stabilised at a level nearer to the norm of around 0.8 units per kilogram of body weight per day. In this case, you will need a close support system to begin with, although there are now plenty of examples of successful glucose management in children as young as this.

DOB