September 27, 1999
Question from Olympia, Washington, USA:
My six year old son has had diabetes for three years now, and although we love his doctor and diabetes team we have recently developed a difference of opinion. My son's sugars have always been high and low, despite carefully watching his diet and activity etc. Recently we started using a sliding scale of his Humalog, partially with the blessing of his doctor and partially with the encouragement of other parents at a recent ADA family retreat. Our medical team is actually against this (even though the doctor went along with it to begin with). We feel like after three years of not being aggressive and just working on changing the standing dose, that a sliding scale works really well. What are your thoughts on this?
Of course we can’t give you individual medical advice, however, if you are uncomfortable with your care, and you have the option of a second opinion, I would seek it out.
Diabetes care should be individualized, so there is no “one” way. The blood sugars go up and down in spite of your best efforts. Only a clinician taking care of your child can help you assess how the diabetes care is going. The clinician would assess growth and development of the child and psychosocial issues, food and exercise patterns, as well as the hemoglobin A1c and blood sugar records.
Concerning insulin adjustment, there are two approaches to adjusting insulin. The first is to look for patterns by time of day, or based on exercise patterns and foods. This is the “preventive” approach. It is essential to know when the different insulins are working to know how to adjust them. Then in addition, the second method, a day-to-day adjustment of (usually short acting) insulin can be done for high or low blood sugars.
It is important to look carefully at preventing highs and lows rather than just responding to the highs and lows. Sometimes if there is a high blood sugar following a low blood sugar it is better to “ride it out” rather than adding extra insulin.