April 3, 2001
Daily Care
Question from the USA:
My two year old daughter was just started on 0.5 unit of Humalog at her breakfast meal. She is pre-clinical without antibodies. Her HbA1c has never been over 5.7%. She has had many highs, but they aren’t consistent. Most of the time, her sugar is in the normal range. From time to time, she will run high for no apparent reason. Usually, her highs are after a snack including a ‘juicy’ or sugar drink. They range from 200 to 320 mg/dl [11.1 to 17.7 mmol/L]. We have also had this checked by the lab, so I know the numbers are accurate. Is this just normal for an “after snack” sugar level? They seem to be going down quickly enough to keep her HA1c normal. I am still uneasy about starting her on the insulin. She goes to about 70 mg/dl [3.9 mmol/L] one hour after the shot. Do you think she should just get the shot when she is high or get the shot every day even when her numbers are okay? I think the doctors just want to see what it will do. I don’t think they really know what to do. I suppose she may be developing diabetes, but I feel like we should just wait until she is “full blown”. What do you think?
Answer:
With a normal hemoglobin A1c, a negative antibody test, and largely normal blood glucose levels, I am not convinced that your daughter has diabetes. The negative antibody test means she has not got type 1A (autoimmune) diabetes which is by far the most common form in Caucasian children. I think that the odd high blood sugar erratically or after a snack could well be due to the combined stress of having her finger stuck and your anxiety. The present dose of insulin is negligible. about.04units/kg of body weight, and personally I would discontinue it, but monitor fasting blood sugars occasionally. If she does turn out to have what would now be called type 1B diabetes and needs to go back on insulin I think it would be safer to start with a longer acting one like Lantus (insulin glargine) (when it is available) or NPH.
DOB
