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March 4, 2004

Blood Tests and Insulin Injections, Daily Care

Question from Phippsburg, Colorado, USA:

My 22-month old son was diagnosed with type 1 diabetes at 15 months of age. We switched to Lantus, with additional doses of Humalog every time he eats. The problem I am experiencing is that the number of shots to get good control has increased to where now he is receiving six injections daily, one Lantus injection, plus injections for breakfast, lunch, afternoon snack, dinner, and bedtime snack. My concern is that this is too many injections, and that because of his small surface area, even with adequate rotation, we may end up with injection site problems. Is this too many injections? And, if so, what would your recommendations be on another way to get good sugar control in a very active and unpredictable toddler?

Answer:

I am not aware that children who have repeated small injections of insulin are at a more increased risk of lipohypertrophy at injection sites than those who receive larger doses less often. However, that said, it does seem like many injections for a toddler, although I have seen some families do that type of regimen quite effectively for a long time. I would make sure that you are using carbohydrate-insulin ratios at meals and snacks and corrective doses at meals to calculate his insulin most effectively. If he has a fairly regular pattern, you may be able to get away with using some Regular or NPH to help cover his more set meals, rather than doing Humalog with every single meal. Some toddlers are really grazers and will eat meals over two to three hours, in which case Regular can work reasonably well for meal coverage. In my experience, many children this age do very well with two to three shots per day of short acting insulin, mixed with NPH at breakfast and supper or bedtime, and by doing carbohydrate/insulin ratios at breakfast, supper, and bedtime snack, can get good control without making the regimen too chaotic.

If you are using these formulas and Lantus effectively, you have all the knowledge tools that you would need to consider an insulin pump. You would need to discuss this with your physicians. Although, in our hands insulin pumps have not produced better blood sugar control than intensive insulin injections, the families of toddlers on pumps have been very pleased with the increased lifestyle flexibility that a pump can afford.

LAD