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March 14, 2007

Daily Care

Question from New Jersey, USA:

Since January, my son has been running high, sometimes over 400 mg/dl [22.2 mmol/L], but usually just over 200 mg/dl [11.1 mmol/L]. We have our ups and downs. Some days, he is under 200 mg/dl [11.1 mmol/L], but it seems like he is over 200 mg/dl [11.1 mmol/L] or even 300 mg/dl [16.7 mmol/L] more than he is under it. The nurse at my endocrinologist's office has changed his dosing by increasing his NPH in half unit increments. We are now up to three and a half units of NPH in the morning and NovoLog at lunch, dinner and sometimes bedtime, if over 300 mg/dl [16.7 mmol/L]. I am in the process of trying to find another pediatric endocrinologist and am having a hard time. I would just like to know if these numbers sound normal. I feel like my endocrinologist/nurse feel as if I am overreacting to these numbers. I was told at the beginning, by the endocrinologist, that my son should be under 200 mg/dl [11.1 mmol/L]. Aren't these high numbers going to effect him in the long run? When he is high, he is urinating in his pants, his cheeks are very red and he is very moody. He also complains that his stomach hurts. After every increase in NPH, my son is still running high. Any information you can provide me with would be greatly appreciated.


A reasonable blood sugar goal for a three-year-old is typically 100 mg/dl [5.6 mmol/L] to 200 mg/dl [11.1 mmol/L], with an emphasis on trying to avoid lows. This is not an age in which we typically strive for stringent control of blood sugars. Usually, when a child is seven or eight, or even a little older, we encourage families to strive for more aggressive blood sugar control with a goal range of 70 mg/dl [3.9 mmol/L] to 150 mg/dl [8/3 mmol/L]. It is common to have blood sugars that are over 200 mg/dl [11.1 mmol/L] in your son’s age group. It would be very reasonable to try to adjust his insulin dosing to keep him generally in the range of 100 mg/dl [5.6 mmol/L] to 200 mg/dl [11.1 mmol/L] knowing that no matter what you do, you’ll still have occasional highs and lows. NPH is not the best choice for a basal insulin, typically. You may wish to see if your diabetes team would suggest using a longer acting basal insulin such as Lantus. It will remain important to review his blood sugars carefully on a weekly basis and make occasional changes to his insulin dosing to try and keep him in a reasonable blood sugar goal range.