For several weeks, my three year old daughter, diagnosed two months ago, had blood sugars less than 70 mg/dl [3.9 mmol/L] three to five times a day, but her endocrinologist did not want to adjust her insulin dosage. So, she ended up in the hospital where they finally told me to lower it. Now, three weeks later, her numbers are 240-450 mg/dl [13.3-25 mmol/L] for a full week, but still her endocrinologist will not allow me to adjust her insulin. He says it is “too early.” Is there any reason not to adjust her dosage if she’s so out of control? Isn’t adjusting the insulin dosage the best way to care for her?

I understand your concern. There are a couple of approaches to take this early in the course of diabetes and none has been shown to be superior to another in terms of long term outcomes.

The first approach is the one that apparently your daughter’s endocrinologist has taken which is a conservative approach knowing that your three year old will likely soon honeymoon, and her glucose levels will likely smooth out on their own. The advantage of this is less “chasing” the glucoses, avoiding marked fluctuations in highs and lows, and perhaps some others, and, as long as there are no ketones with the higher readings, you can be assured that there is no imminent danger of DKA [diabetic ketoacidosis]. The disadvantage is that the numbers “look bad”, and the child certainly may be experiencing increased urination and thirst, and has some increased risk of infections, some not-so-serious like yeast infections, others perhaps more so.

Another approach is a bit more aggressive with on-going adjustments in order to avoid these highs. The disadvantages are more likelihood of some lows, as she experienced before with “tighter” control, but you do get peace of mind.

I am not aware of any data that suggest that in the long-term, either of these approaches leads to worse complications of diabetes two, five, 10, or 20 years later.

My own approach is to be a bit more aggressive than your daughter’s endocrinologist is doing, but that might be to make my patient’s more comfortable. I would hope that you have a growing trust of your daughter’s endocrinologist. She is being followed by a pediatric endocrinologist, isn’t she? If not, then please get a referral!

DS

[Editor’s comment: You night try using new unopened vials of insulin. Insulin that has been open for more than 30 days (especially if kept at room temperature) tends to lose its potency. Another idea might be to give her Humalog after her meal so you can base it on what she’s actually eaten.

I think you’ll find the book, Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin a great reference for managing a toddler with diabetes. I highly suggest you purchase it.

SS]