My nine and half year old son, who has had type 1 diabetes for about four months, weighs 43 kilograms (95 pounds) and takes a total of 40 units of insulin (Actrapid with Insulatard) per day. I understand that he must take a total amount of insulin per day equal to his weight, but he measures his blood sugar with every meal and decides the dose required as that time accordingly. Is this right? Do the doses have to be fixed for getting better control?

It’s not an easy task to properly control sugar metabolism over time in a boy. You both must be congratulated if this goal has been reached as it seems from what you write. What about his hemoglobin A1c level since the diagnosis? Did he stabilize close to 6.5%?

Your son’s weight is probably a little bit above what is the ideal one, and the 40 units of insulin per day are parallel to this. In fact, total requirement of insulin is generally calculated on an ideal body weight, and, to be frank, his dose is the average requirement of an adult or an adolescent during puberty.

I would reconsider his caloric intake.This means you should aim at this right now. Adjusting the Actrapid dose before each meal according to blood sugar, exercise and meal intake is absolutely right. I’d talk to your son’s pediatrician about the possibility of a referral to a pediatric diabetes team where there is a dietitian available.

MS