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June 24, 2003

Daily Care

Question from Whitaker, Pennsylvania, USA:

My son was diagnosed less than two months ago, and diabetes team stated that the best way to get good control of his type�1 diabetes is to adjust insulin with the amount of food he eats. However, he is on fixed injections of NPH in the morning, Humalog before dinner, and NPH at bedtime. His numbers are pretty good (usually 90-150 mg/dl [5-8.3 mmol/L]), but sometimes he doesn't eat well at meal times. His team said that if he wants a meal at a non-meal time give him Humalog, and I need to know how I judge what to give him. Adjusting insulin according to carb intake is not a strong area of knowledge for us. Does this apply to any part of the day that is between meals?

Answer:

The most successful strategy for dosing rapid acting insulins such as Humalog or NovoLog is to base the dosing on carbohydrate intake. Usually, in newly diagnosed children, I start with a dose of 1 unit for each 20-30 grams of carbohydrate. Testing the blood sugar two to three hours after a meal will help you determine if that is the correct dosing for your son. If the blood sugar has returned to within 20 points of the pre-meal level after the meal, then the dosing is likely correct.

Making adjustments to this strategy requires the expertise of someone reviewing your son’s blood sugars with some regularity. This can be done by your diabetes team — and eventually, you too can learn to make small adjustments to better meet his needs. I would phone or fax seven days of blood sugars to your diabetes team. Also, ask them where you can get additional training in carbohydrate counting.

MSB