My step-son is 6 years old and was diagnosed with type 2 when he was 3. His sugar levels are always fluctuating, from registering as “Lo” up to the 400’s. What can be done to regulate it more? We watch what he eats but are concerned how this will affect him. He gets 2 insulin shots daily.

If your stepson is from a Hispanic family it is possible that his real diagnosis is Type�1B non-autoimmune diabetes and not Type 2. However, making a specific diagnosis at this stage is not particularly important because after this interval he is unlikely to be one of the ones that become insulin independent after a time and it implies no change in treatment. To achieve better control you are going to need some help and the best arrangement would be to work closely with a diabetes nurse educator, preferably one in your doctor’s team. If this is not possible then you might consider care in such a team which you could find either by calling the nearest office of the American Diabetes Association or by looking in Finding a New Diabetes Doctor.

In the meantime, you need to find out what your stepson’s A1c tests have been: this measures the amount of glucose attached to hemoglobin in the red blood cells and is a rather good measure of the average blood sugar over the last three months and therefore of the degree of blood glucose control. You also need to build up a profile of blood sugars throughout the day, doing them routinely before breakfast, before supper or before bed as well as occasionally in the early hours of the morning and as appropriate in relation to vigorous exercise, changes in dietary pattern and mood. With all this information it should be possible to work with the diabetic team to reformulate the kind and amount of insulin to achieve more uniform blood sugar control.

DOB