Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
October 1, 2001
Question from Winston Salem, North Carolina, USA:
My 13 year old has had type�1 for almost two years, and one doctor recommends giving half as much Humalog as she would usually take for a supplement at bedtime when her blood sugar is high, but another doctor (that she sees now) absolutely doesn't want her taking Humalog before bedtime no matter how high she is. I am torn between letting go to bed with high blood sugar (possible long term complications) and giving the Humalog like we used to. Do you know what most people do in that situation?
First of all, it would be helpful to know if your daughter is followed by a pediatric diabetes specialist or pediatric endocrinologist. Why did you change? I think it would helpful, if possible, to follow up with the diabetes team with which you and your daughter are most comfortable. What has her hemoglobin A1c been running? What are her doses of insulin? Is she on an insulin pump? What level of glucose does she wake up with in the morning?
Personally, I prefer that my patients not “chase” blood sugars routinely by giving extra fast-acting Regular or Humalog. On the same concept, I don’t like “sliding scales” of fast-acting insulin. My general treatment suggestions are that if the blood glucose (at any time) is greater than 240 mg/dl [13.3 mmol/L] to then check the urine (or blood if you have the capacity in your meter) for ketones. If the ketones are moderate or more, then extra fast-acting insulin may indeed be required. If negative ketones, then the goal would be to try to provide enough insulin during the routine doses to prevent the glucose from getting too high. At bedtime, I would want the glucose greater than 100 mg/dl [5.6 mmol/L] and generally less than 180 mg/dl [10 mmol/L] (preferably closer to 150 mg/dl [8.3 mmol/L]). However, I don’t think extra insulin would be required unless there are ketones.
Your question could be answered better, I think, if we knew more details.
[Editor’s comment: My advice is to avoid giving short-acting insulin (Regular, Humalog, or Novolog) at bedtime unless somebody sets an alarm clock to check a middle-of-the-night blood sugar.