December 11, 2002
Daily Care, Sick Days
Question from Calgary, Alberta, Canada:
My six year old son who has had type 1 diabetes for approximately two years, broke his left shoulder clavicle a couple of weeks ago, and we are having an extremely hard time getting his glucose numbers within acceptable target ranges even with a sliding scale. I have several questions:
How does a Doctor derive an “Insulin Sensitivity Scale”?
Is it normal to have glucose numbers so radically high after an injury that happened two weeks ago?
Is it normal for the NPH to change so dramatically when injured?
Will the NPH dosage decrease after healing of clavicle has progressed?
Is there anything else that can be done to help his diabetes?
Would Lantus (insulin glargine) insulin be a acceptable alternate for his current regimen to alleviate the highs?
Answer:
How are insulin doses divined? Guesswork is the best answer. Trial and error another. Clinical skills a third. Basically, I have seen a child like your child before. I know what worked and start from there. Age, stage of development and activity affect the ratios. Here there has been stress, healing is occurring and likely the fracture has changed activity. All have contributed to increasing insulin need. I would follow the sugars and adjust the insulin. Up today and down tomorrow. As to a radical change in this time, I would wait.
LD
[Editor’s comment: It’s described in John Walsh’s book Stop the Rollercoaster. But whether your son’s doc is reading that book, or modifying a concept he learned somewhere else, is impossible for us to predict (Of course, you could ask the doc…).
SS]
