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August 12, 2007

Daily Care, Hyperglycemia and DKA

Question from United States:

What is the normal protocol for blood sugar levels that are too high at a meal time? For example, if the person with diabetes has a blood sugar of 300 mg/dl [16.7 mmol/L], should you give insulin then wait 30 minutes to an hour before eating, give insulin and wait until the blood sugar returns to normal range and then eat, or give insulin and skip a meal? I know that specifics for each person should be based on a medical plan made with their health care professional, but what is the norm?

Answer:

As you mentioned, it would be best to make a plan with your health care professional. However, for general information, the treatment for an adult would differ from a child. An adult may wait a bit longer between the insulin dose and the food, in order to let the insulin start working and get the glucose to come down a bit. They may take additional insulin and also change the types of foods they would have at that meal, in order to prevent an even further rise in glucose. They may eat less, or even delay/skip a meal.

For a child, you may take extra short acting insulin, according to the plan discussed with your health care professional. It is not usually easy to wait before eating, but if it works out, that may be an option. It is important for a child to eat a well-balanced meal and they would not skip meals for high glucose levels. If they are extra hungry, offer extra of something that may not raise the glucose as much. When possible, try to figure out why the glucose is high before the meal and learn ways that may prevent it. Try not to make the high glucose a punishment for them that takes away their food or makes them feel bad about eating.

LM