My six year old daughter has had type 1 diabetes since she was 18 months of age and is in excellent control. We use a sliding scale to adjust her insulin dose based on her readings or how much she wants to eat. We recently were told by a pediatric endocrinologist that the sliding scale is not appropriate for a child so young. I need help! Is this true? This endocrinologists says most pediatric endocrinologists do not support a sliding scale.

The dosing of insulin and the way to calculate that dose varies depending on the preference and skill of the physicians in treating diabetes. I would suggest that you continue to be creative and flexible in how you dose your child’s insulin and set reasonable goals. If, indeed, your child is in excellent control, then I would suggest that you are doing what is right for your child.

Sliding scales for insulin are sometimes frowned upon because if a child is frequently having to use a sliding scale for high blood sugars, then one should make a change to prevent those high blood sugars. However, in my practice, I have good success with sliding scales for high blood sugar but also instruct my patients that if they are having blood sugars that are routinely out of their target range, they should be contacting me for a change in their insulin to help prevent those high blood sugars — rather than just routinely chasing them with a little extra Humalog or Regular insulin.

MSB