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July 6, 2000

Daily Care

Question from North Carolina, USA:

My son was diagnosed at age 6, now 7. His 2-3 hour post meal number almost every day is 200-350. I ask his endocrinologist if a small amount of Humalog at lunch would correct the problem since my son only takes 2 shots/day. He says no. Also says for me to quit taking post meal numbers and stick to the 4 times/day regimen, yet everything I study says to be very concerned with post meal numbers. I have worked so hard for these past 14 months to do this thing right, only to find out most days "nothing is good enough". Our quality of life is suffering deeply. We're headed for the pump soon in hopes of getting better A1c's (which average now 7.5-8.2). Also, do you think A1c's will improve with pump and how do you feel about children this young on pumps? P.S. I know the GlucoWatch has been tested in 18 and older only, but then "Insulin" was never tested on "kids" either, so, how do you feel about the watch for night time security if nothing else? Thanks, from a worried mom.

Answer:

The way insulin is dosed varies from physician to physician. Most authorities would agree that taking some rapid acting insulin such as Humalog or Regular insulin whenever you eat carbohydrates is the most successful way to control blood sugars. In addition, it is important to use a longer acting insulin such as NPH, Lente, or Ultralente to provide a basal rate rate of insulin which the body needs regardless of carbohydrate intake. On the insulin pump, both can easily be provided. It is likely that you can decrease the hemoglobin A1c simply by changing to pump therapy, continuing to pay attention to details, and having routine follow-up with your son’s diabetes team.

The GlucoWatch is not a very good option for a 7 year old at this time (it’s not yet available, as of early 2000) — maybe in a few months that will change — we’ll see.

I agree that post-meal blood sugars are not a real help right now with a child with Type 1 diabetes. I would suggest you continue to monitor the sugars before meals and before bedtime with an occasional 2�A.M. blood sugar to help maintain good control of blood sugars. It is important to review those blood sugars with your diabetes team at whatever interval they suggest — and certainly more often if the blood sugars are routinely out of the goal range.

MSB