My six year old son was diagnosed with type�1 diabetes a year ago and takes shots twice a day (mornings and evenings). He is a picky eater and breakfast is his favorite meal of the day. To avoid hypoglycemia, I give him a heavy breakfast at 7:00 am, skip the mid-morning snack and feed him his lunch (which usually he never finishes). They check his sugar level at school about 11:00 am, and he is usually greater than 170 mg/dl [9.4 mmol/L]. He’ll get an afternoon snack if his sugar level is not too high. He gets a normal dinner and an evening snack before going to bed. Is this acceptable? How many hours after every meal should my son’s sugar level be within the normal range?. Also, if his sugar level is above 300 mg/dl [16.7 mmol/L], I check for ketones and they’ve always come back negative. Should I be concerned?

You did not indicate your son’s insulin regimen, but since he is skipping snacks, then I presume he receives an intermediate acting insulin (such as NPH or Lente) plus Humalog.

There is more and more attention, especially in adults about the importance of blood glucose control after meals (postprandial), but I am not certain that at the present time, we can be so worried in children, especially given the finicky and picky nature of many children’s appetites, along with changes in tastes and eating habits.

If your son is on Humalog, then the dose of Humalog ideally covers the meal in of itself so his reading two hours after a meal should be within 50 points of his pre-meal reading. If he is having higher readings at 11:00 am after a meal and insulin at 7:00 am (and with no snack), then there are a couple of things you can consider:

Less protein with his “heavy” breakfast –especially if he is not so hungry later.
More insulin at breakfast. Either more Humalog or (my preference) give a bit more NPH.
Change to Regular at breakfast from Humalog. Already on Regular? Then give a bit more (rather than the NPH noted above.)
Do nothing! Are his hemoglobin A1c readings good? If so, then I might ignore the few higher readings (“the trees”) and focus on the big picture (“the forest”) and realize what a good job you are doing. If his HbA1c values are not optimal, then it would seem appropriate to discuss with your diabetes team about making some changes.

It is appropriate to check for ketones when the blood glucose is high (I usually recommend higher than 240 mg/dl [13.3 mmol/L]), and I am glad that his ketones are negative.

DS