October 29, 2001
Blood Tests and Insulin Injections
Question from Dansville, Michigan, USA:
My two and a half year old son, diagnosed at 20 months, has been on an insulin pump for eight weeks. We are very pleased with the results (improved control, lowered A1c [from 8.7 to 8.2% in the first five weeks], and wonderful flexibility), but his diabetes team feels that I am testing his blood sugar too often. They want me to test pre-meal, two-hours after meals, and once or twice during the night (approximately seven to eight times per day). I agree that this would be ideal, but my son is not a structured meal eater. Many times he is more of a “grazer”, so testing pre- and post-meal is often not possible.
If he snacks several hours in a row, and receives a bolus for each snack, I tend to check him more often to see if the insulin is “catching up” with him. Also, because of his young age, and his inability to communicate when he is low, I will often check him before nap, with increased activity, before leaving him with a care giver, or for any unusual behavior which might lead me to believe something is amiss. Some days this can add up to 12 or 13 checks.
While I agree that it is best to try to limit the checks as much as possible, it seems that in a child this age, one would want to err on the side of caution. What is your recommendation for frequency of blood glucose testing in a two year old on an insulin pump?
Answer:
There is no absolutely right number of times to check blood glucose levels. The number of times you are checking is certainly very high so your diabetes team may be correct that you do not need all this information.
You should continue to have discussions with them about how you are using this information, whether or not you could use less information and come to some consensus. Lots depends upon your goals, the fact that you are dealing with a toddler who cannot always communicate as well as he may in the future, etc., how his hemoglobin A1c values are running, etc.
SB
