November 17, 2010
Daily Care, Hyperglycemia and DKA
Question from Ohio, USA:
My son was diagnosed with type 1 diabetes about eight months ago. He seems to be completely opposite from everything I read and so we are having a very difficult time with blood sugar control. He has been on an insulin pump for the past month and we are still working to level him out. Activity causes his blood sugar to elevate instead of decrease. He runs extremely high during the night and we have to dose him manually every night at 3 a.m. and sometimes at midnight as well. During the day, when there isn't much going, on he drops, sometimes into the 40s mg/dl [2.3 to 2.7 mmol/L] and it takes much longer than 15 to 20 minutes to bring up his sugar, even with juice. He will usually lie around for about 45 minutes before finally starting to feel better. I just feel so lost and that there is no way to gain control over his blood sugars. My son takes NovoLog. His basal rates are 0.175 from 6 a.m. to 6 p.m., 0.2 from 6 p.m. to midnight, then 0.3 from midnight to 6 a.m. He still ends up over 300 mg/dl [16.7 mmol/L] at 3 a.m. I actually double-checked these today with the pump and they are correct. I had to leave work early again because at 4 because his sugar was only 39 mg/dl [2.2 mmol/L]. My son is four and my mother is his caregiver when I am at work. She went through all of the training with my husband and me and she calls me at least three times daily at work with updates and/or questions, and only feeds him what I instruct for corrections. She is very accurate. His most common lows are after breakfast and before bed, both of these times are when my husband and I are home. Sometimes he will drop after lunch as well, but not as regularly. His highs are usually after elevated activity (he played softball in the spring and is currently playing soccer) but during the night, while sleeping, is when he is at his highest. He sees his diabetic team next Tuesday and I did phone in his blood sugar levels today for the past three days; I am awaiting a call back. I am trying to understand the situation myself, so any ideas you may have are appreciated. I can tell you that his first A1c four months after diagnosis was 7.3. We did very well with everything up until about two months ago, then things fell apart.
Seems very unusual to have such unstable and unpredictable blood sugars. It impossible to give any specific advice except to stay in close contact with your diabetes team. In my practice, we would review pump downloaded data twice a week and adjust basal and boluses. Plus, be sure proper timing of boluses and carbohydrate counting is not contributory.