January 19, 2003
Blood Tests and Insulin Injections
Question from Madison, Georgia, USA:
My husband and I saw the GlucoWatch in Diabetes Forecast, and we were interested in it for our daughter, who is a toddler, but it reads as if it is only for children about the age of seven. Our daughter has been considered in a critical state since she was diagnosed because she has yet to be controlled. Her blood sugars are all over the scale and she will be starting school within the next year or two. We thought it would be a good way to watch over her, along with her regular routine. Can the GlucoWatch be used for younger children? If not, why?
The GlucoWatch can be used in children younger than seven, even though it has not yet been approved by the FDA for that age group. The delay in approval is really a financial one and reminiscent of what happened with the introduction of Humalog a few years ago.
You should be sure to get the GlucoWatch II, which is more expensive than the earlier model but is smaller and has a shorter equilibration time. The instrument is quite expensive, and unless your daughter has had at least one severe hypoglycemic episode, it is likely that your insurance company would not pay for it. The accuracy is good however, and clearly it could have a special place during illness or when there are concerns about night time hypoglycemia.
Controlling blood sugars in the preschool child is notoriously difficult because of the vagaries of mood, appetite and exercise. So I think that you might discuss with your daughter’s diabetes team the alternative possibility of developing a 24 hour blood glucose profile using either a FreeStyle or One Touch Ultra meter — which are essentially painless — and then considering Lantus (insulin glargine) at bedtime as a basal insulin with Humalog or NovoLog just after meals so that you adjust the dose for the premeal blood sugar and appetite.
[Editor’s comment: Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin is a great reference for managing a toddler with diabetes.