My daughter, age 13, was diagnosed type 1 in January of 2004. We're almost 8 months into this and she is now starting to come out of her honeymoon phase. Her numbers are high all the time and her doses of Lantus and Novolg are still quite low (6 units Lantus and carb ratio of 35:1 for Novolog). We see a diabetes team every 3 months but I can contact them by phone or fax at anytime. I fax them her blood sugar numbers about once a month (or more if needed) and I was told last time to leave the insulin amounts the way they are. Her numbers are always between 200 and 300 except for one "low" of about 80 that hits each day right before lunch.

These high numbers are definately out of my comfort zone and I have told this to the diabetes team. They aren't concerned about the highs, but more concerned about the low of 80 at lunchtime. They don't want to raise her insulin for fear of nighttime lows. She's NEVER low at night, in fact she goes to bed with a number of around 200 and usually wakes up with it higher than that! She hasn't shown ketones at all.

Seems to me I should be raising both the Novolog and Lantus and giving her a snack in the midmorning to counter the lunchtime low, and of course monitoring her at night to make sure she doesn't run low. But they say to just keep things as they are.

I guess my question is this....Does my daughter's diabetic team seem too non-aggressive in treating this condition? They are supposedly top-notch, best in the area, and in fact people come from 3 states to use this clinic, which is at a top children's hospital. Just seems to me we should be raising her insulin along with her raising blood sugars.

Thanks in advance for any insight you can give me.

I would not be happy either. My son is 5 and weighs 50 lbs. He also get 6 units of lantus and he is 25:1 novalog. I am not the Dr, but I would increase the novalog. She may not be 35:1 anymore. Her fasting #'s are way to high if she's waking up higher than 200. You really need to talk to some one from that office. If no one is calling you back, then drive over there! That's what I would do. You know things are not right for her. Good luck!! Amie

...and besides which, who EVER said that a reading of 80--especially right before lunch--is anything like "low"?!? In fact, it's perfectly normal, just exactly where you want to be all the time. Although, if she's not showing any ketones, then she's in no immediate danger either--BUT, I'd not be too comfortable with those readings either. Generally, the basal dose of lantus is calculated on body weight. the approximate formula is: weight in kilos times .6 = approx. total daily insulin dose (TDD). 60% of that dose is usually basal, and the remainder, depending on food eaten, would be bolus. For example, I weigh 135 lbs, divided by 2.2 = 61 kilos. 61 times .6 = 36.6 TDD, and 60% of 36.6 = 22 units. In fact, I take only 17 units, mostly because I am extermely muscular, and increased muscle mass utilizes insulin more efficiently, but it gets us in the ballpark. Plug in your child's weight and see where you are--5 units would cover an average child of maybe 30-40 lbs or so, and I doubt that your 13-year old is that tiny! Even as a young teenager, I was taking over 25 units, and as puberty hit, my dosages climbed, sometimes suddenly and drastically. The insulin/carb ratio also need adjustment for you to get her numbers stable--15:1 to 20:1 is more normal for a still-growing teen. Don't be put off--demand reasons why they think 200 is a tolerable number!

Michael
T1 since 1965

(formerly Linda16299)

Hi,

Thanks for the replies. I talked to one of the doctors yesterday and she was much better than the person I talked to last time. I deal with a team and I never know who is going to call me back. But, like the last doctor, she said the numbers shouldn't concern me, this is still honeymoon time and they don't want to raise the insulin too quickly. But, she was better than the other doctor because she said we should definately raise the Lantus. We raised it to 7 units and we'll wait 2 weeks and see how that goes. She did say that eventually, my daughter should be taking about 15 units. Which makes sense since at dx she was taking 18 (and then steadily down during honeymoon). She also said it was fine for me to change the mealtime ratio, which I did. Last doctor just kept saying 'no, don't do anything'. Sometimes I think they just don't like to be second-guessed and don't like the patient to have that much say in their own health care.

I was glad to read your reply. I was about to say that actually, they are doing the typical treatment with a new diabetic. Blood sugars that drop too low can kill you. This is why most Dr's are more concerned with lows than highs. There are no hard and fast rules until she gets out of the honeymoon. After that, you should expect a regimine that requires blood sugar checks and insulin adjustments to suit. Good luck