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September 17, 2020

Hyperglycemia and DKA, Insulin

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Question from Pakistan:

My nephew, weight 28 kg [61.6 lbs], was diagnosed with type 1 diabetes in the second week of August 2020 with a HbA1c value of 14.5%. A doctor from a government hospital prescribed him Mixtard 30 HM injection with 12 units every morning and 12 units every evening. During the first week, his fasting sugar level remained near 150 mg/dL [8.3 mmol/L] while after breakfast and controlled diet, his usual levels were in the 350 to 500 mg/dL [19.4 to 27.8 mmol/L] range. His daytime sugar levels are not in range despite the doctor increasing the units from 12/12 to 15/20. Even after changing dosages, 2 hours after breakfast and 2 hours after dinner, his sugar levels were still 300 to 500 mg/dL [19.4 to 27.8 mmol/L]. Currently, his doctor advised 26/26 units of Mixtard 30 HM, but we are seeing no improvement. Please suggest what should we do to get his sugars to target and is it okay to give a child 52 units in a single day? Please advise.

Answer: