Our 12 year old daughter was diagnosed with Type 1 approximately 6 weeks ago. Her blood sugar range is 60-150. She is within range in the morning, at lunch and on the weekends, but every afternoon after school, she is over 500 and sometimes 600. She swears that she is not eating junk at school, but I am sure she is. Her doctor does not seem to be concerned, but I’m worried about the long term affects of high sugar levels. Her current insulin dosage is 5R, 14N in the morning, 5-8R before the evening meal and 9N at bedtime. I know that we can increase her morning N dosage to bring down those late afternoon levels, but I would rather see her eat more responsibly.

I certainly understand and agree with your goal of improving your daughter’s afternoon blood sugar control. At 500 and 600, she can’t be feeling well for a good portion of the day and this may be having an effect on her mood, energy, clarity of thinking and other matters. However, in view of the fact that she has only had diabetes for about six weeks, I believe that overall you are all doing quite well.

Let me give a bit of background. Type�1 diabetes cannot be controlled by food restriction. There must be adequate insulin to control blood glucose. Trying to “starve” blood sugars into control never works, and is even more risky in children than in adults, since they are still growing. Calorie (energy) needs are determined not by their diabetes or the current insulin dose but by body size, level of activity and whether the child is currently in a growth phase. Either eating too little or taking too little insulin to manage the food that’s eaten can result in your daughter not reaching her full growth potential.

So, how to get the control that you seek? The only way is to achieve a balance in both amount and timing between insulin and the food that’s eaten. And that takes some detective work. It is the total amount of carbohydrate that she’s eating during school hours that is of interest. Her blood sugar could just as easily be at its present level from eating more whole wheat bread, potatoes and fruit than her insulin will cover, as from eating “junk.” So the first step is finding out what’s actually being eaten. It may also be helpful to test blood sugar in the middle of the afternoon on the weekends, for comparison. Someone familiar with both diabetes management and the growth needs of youngsters should review these records. Armed with information about what is actually being eaten and the blood sugars before and after meals, your doctor, dietitian or diabetes educator can make some judgements about best steps. Possibilities include, but are not limited to, increasing the morning dose of NPH or redistributing food over the broad peak of this insulin’s action. If your daughter is not already eating an afternoon snack, this will undoubtedly be needed if the morning N is increased to give more lunchtime “oomph.” The peak of N lasts quite a while and might cause low blood sugars before dinner if a snack isn’t taken after school.

Diabetes control is quite a juggling act — for the whole family! Your daughter needs both your help and your confidence that she can learn to make good choices. This is a skill to be built, not a set of rules to be followed perfectly from the start. The more information and support you all have, the better. This can help you be more calm about the food choices your daughter makes. Because I can guarantee you that they won’t all be great. No one’s food choices are always great. But try to guard against making food a source of control struggles and arguments. Diabetes control and family relationships both suffer when that happens.

BB