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March 25, 2019

Hyperglycemia and DKA, Meal Planning, Food and Diet

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Question from Palm Springs, California, USA:

We have been giving our eight-year-old daughter about 50 To 60 grams of carbohydrates per meal and plenty of high fiber foods, but her glucose levels keep exceeding 250 mg/dl [13.9 mmol/L]. Her ketones are always none to trace. Her eating habits always included snacking throughout the whole day. What if I give her six small meals/snacks throughout the day? I hate to see her struggle.

Answer:

You did not give enough information about her insulin dosing, but if all her blood sugars are high, then her basal insulin doses likely need to be increased. This can be done with overlapping doses of Lantus or Levemir (or even old-fashioned overlapping NPH doses). If her pre-meal blood sugar levels are fine, but the post-meal (post-prandial) blood sugar levels are all high, then she needs higher mealtime bolus dosing to cover her carbohydrate intake. If you are doing pre- and post-meal blood sugars, within two to three days you should be able to identify a pattern and then compensate with the appropriate insulin. If you are still stuck with a high A1c, high blood sugar readings, then take the blood sugar data to and discuss this with your diabetes team for more specific recommendations. Editor’s Comment: Please be sure to discuss changes to your daughter’s insulin regimen with your diabetes team. You may also wish to discuss her meal plan with a dietitian.