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June 3, 1999

Hyperglycemia and DKA, Insulin Pumps

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Question from Lincoln, Nebraska, USA:

Our 9-year-old son was diagnosed almost 2 years ago with Type 1. We are struggling with morning high blood glucose readings. He’s on Humalog and NPH, and I can almost always get normal readings for lunch, supper and bedtime by adjusting his morning and supper injections. We suspected nighttime lows and rebounds, and started checking more frequently at night, which did confirm our fears and his bedtime insulin was reduced, by about 30%. We had a couple good morning readings, but they are back up again, and even though I’m checking at midnight and 2:30 A.M., and again at 4:15 A.M. (roughly), I can’t seem to catch any lows. His current dosages are 1-3 H & 15 1/2 NPH at breakfast, 2-3 H at supper, and about 10 NPH at bedtime (we had been up to 17 NPH bedtime during a time a few weeks ago when he had a cold).

My biggest concern is that he is scheduled to receive a pump in a few weeks, and we need to get this bedtime dosage figured out by then, don’t we? His latest A1c was 8.8%, even though his meter reading average was 150, so the endocrinologist suspected nighttime lows and rebounding as well. Where am I missing it?

Answer:

If your son is scheduled to start pumping in a few weeks, I would just do the best you can for now on the bedtime NPH. Try to prevent lows and extremely high morning readings. You will not need to settle this before the pump, as the pump will likely take care of this problem. You will be monitoring overnight to assess your child’s basal needs, and adjusting the basal rate accordingly. Best wishes with your pump start. Although you’ll probably be very tired the first week of the pump start, you’ll likely be very happy as well.

LM