My six year old daughter (50 inches tall, 64 pounds), diagnosed about four months ago with type 1 diabetes, is very tall for her age and really only slightly overweight. (The extra weight is in her belly area.) She currently takes two shots (morning: 2.5 units of Humalog with 8.5 units of NPH; dinnertime: 2 units of Humalog with 2 units of NPH). I wonder if she could possibly have type 2 diabetes because her initial hemoglobin A1c was 9.7%, but it dropped to 6.8% at her two-month followup. I have several questions:

She did not have a C-peptide level done at time of diagnosis. At at her two-month followup visit, her endocrinologist said that she didn’t need one, he even said he would not believe it if it came back positive. How can a physician be so confident my daughter has that it is type 1 instead of type 2? Could we still have a C-peptide level done this late after diagnosis?
What is the typical dose of insulin for a child per pound of body weight?
When checking my daughter in the middle of the night, are there any physical signs that I can look for (without actually doing a blood glucose) that could alert me to a possible low blood glucose?
What is idiopathic diabetes?

I am sure that your daughter’s endocrinologist is right in saying that your daughter she has type�1 diabetes. Although she is over the 90% level for height and weight, the ratio of the two measurements is quite normal giving her a body mass index (BMI) of only 17.4, a long way from being overweight.

In these circumstances, I don’t really think a C-peptide level of any sort is needed. If she had type�2 diabetes, it would probably be normal or a little high, but since she is clearly still making some of her own insulin, there would still be some C-peptide in a fasting sample.

It would nonetheless be reasonable to ask for an antibody test. A positive ICA512/IA2 screening test is inexpensive and if positive would both reassure you that she really has type�1A (autoimmune) and not type�1B which is only found in about 5% of new onset cases in Caucasian families, but, which may, after an interval of a few weeks or months, be controllable without insulin.

Your daughter’s dose of insulin is approximately 0.5Units/kg.body wt./day which is quite normal at this stage but is likely to increase in the next weeks to nearer 0.8 U/kg/day.

I think there are two ways to check blood sugars at night without waking her. The first would be to use the FreeStyle or One Touch� Ultra on the forearm which are essentially painless devices.The second would be the GlucoWatch. The present version is expensive and has some problems with standardisation, so I would be inclined to wait a few months for the next model and to use that only if there was a recognised problem with nocturnal hypoglycemia.

On the same theme, I think you might talk to the doctor about using once a day bedtime Lantus (insulin glargine) for the long acting component. Although it requires an additional injection, it has been shown to reduce hypoglycemia at night. If you did this, it would also be necessary to cover the lunch time glucose rise with Humalog, Novolog, or perhaps by continuing to use a small amount of NPH with the morning insulin dose.

DOB