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July 30, 2003

Daily Care

Question from Rock Hill, South Carolina, USA:

For the past year, my four and half year old son's average blood glucose level has been around 180 mg/dl [10mmol/L] so about six months ago, his doctor put him on NovoLog (by pen) and Lantus. It has worked out pretty well, and overall we have been happy. However, over the past two to three months, I am looking even more closely at trying to control his blood sugars better to the point of creating a spreadsheet and tracking everything. I can't seem lower his morning blood sugar which averages in the 230 mg/dl [12.8 mmol/L] range no matter how much Lantus is given. This dawn rise is obvious since his blood sugar is always high in the morning (e.g., last night, his blood sugar was 46 mg/dl [2.6 mmol/L] at bedtime so I gave him ice cream to get it to rise, an hour later it was 52 mg/dl [2.9 mmol/L]. I gave him a small glass of pear juice, and an hour and half later, it was 60 mg/dl [3.3 mmol/L]. I then gave him a chocolate chip cookie with a half cup of milk, and two hours later (around 2:00-2:30 am) it was 169 mg/dl [9.4 mmol/L]. I thought everything looked pretty good, but he woke up at 9:00 am with a blood sugar of 269 mg/dl [14.9 mmol/L].) Any suggestions?

Answer:

This is very frustrating for you and your son’s diabetes team, I am sure. Here are a couple of things to consider:

We do find that some of the younger children seem to be “fast metabolizers” of Lantus, and since Lantus is approved for morning use now, perhaps a twice daily, albeit smaller, dose of Lantus could be tweaked.
If you’re a good at carbohydrate counting consider an insulin pump.
Consider a dosing change whereby you decrease the Lantus a bit, but add some NPH or Lente to bedtime.
Is the child getting a bedtime snack? If so, do you bolus for it? Maybe you don’t need to.

This is an interesting phenomenon you’ve noted. I think it is very wise to look for patterns and a spread sheet may be extremely helpful. You should talk about this with your son’s pediatric endocrinologist.

DS