My son is 2 years old. He was diagnosed with Type 1 diabetes 4 months ago. He still produces a little insulin on his own (he does not require insulin at bedtime yet, and occasionally skips it at supper). I would like to know if oral hypoglycemic medications are a possible treatment for his diabetes when his blood sugar reading before a meal is normal (between 4-8). We currently give him 3.5 units of N at breakfast, and 0.5-1 unit of Humalog at breakfast and supper.

Most of the oral medications used for Type 2 diabetes do not have a place in the treatment of 2 year olds with Type 1 diabetes. Having said that, the newer agents that have an effect on carbohydrate absorption might be helpful just as the anti-insulin resistance medications may help. They all have some other side effects and are generally not used by us or other pediatric diabetes leaders around the world in type 1 patients.

There are not good studies documenting this and adjusting insulin and meals is the mainstay of current treatment with lots of daily blood glucose testing. This allows parents and health care providers to know when insulin adjustment is needed, doses need to be increased or changed etc.

It is not common to have prolonged periods of time when little insulin is needed in 2 year olds so that a growth spurt or intercurrent infection would likely change the insulin requirement dramatically and abruptly.

I would discuss this with his doctor and nurse educator so that they can answer your questions specifically and relate directly to his actual blood glucose readings, hemoglobin A1c values, etc.

SB