As children grow, their appetites and activity levels change. Their need for insulin also changes. You shouldn’t have to wait
for a regular appointment with someone on the diabetes team to respond to these changes. Who better to keep an eye on the
changing pattern in your child’s blood glucose level and overall health than your family? Studies show that parents and children
who actively take part in diabetes management are the most successful in adapting to the disease.
Remember that if your child needs more insulin or more injections, it does not mean her diabetes is getting worse. In the
same way, if your child needs less insulin, it doesn’t mean the diabetes is going away. Adjusting insulin to the body’s current
demands is simply a way of maintaining good balance and achieving better control. For example, a heavier child may need more
insulin than a smaller child. A child who is always on the go may need less insulin than a child who is not as active. A teenager
will likely need more insulin during puberty than after the growth spurt. Also, an adolescent may need more insulin during
exam week, to balance the increased stress.
To make insulin adjustments on their own, parents and teens must:
-
be confident that
blood glucose checks are correct and meal plans are being followed (i.e. no secret snacking)
-
know the child’s blood glucose target range
-
understand the actions of the insulin being used
-
understand what each blood sugar check means
-
know when to contact the health care team
When to make adjustments
People with diabetes know when change is needed by the way they feel, and by the results of their blood sugar and urine ketone
checks. If your child is sticking to the meal plan closely, continuous high blood sugar readings usually mean that more insulin
is needed. Repeated low readings usually mean that less insulin is needed.
Generally speaking, you can assume that the insulin dose is right and no change is necessary when:
-
your child feels well and does not have
symptoms of high or low blood sugar
-
the urine does not have
ketones
-
7 to 8 out of every 10 of the blood sugar checks are within the
target range
With any insulin regimen -- 2, 3, or 4 injections a day -- it is important to know which insulin is acting when, and therefore
which insulin dose needs to be adjusted when sugar levels are either too high or too low.
Understanding insulin readings: Jane’s story (1)
Jane is a 10-year-old girl who has had diabetes for 5 years. She receives NPH (intermediate-acting) and Humalog (fast-acting)
insulin before breakfast, Humalog at supper, and NPH at bedtime. Jane’s family has learned that each of the 4 daily blood
checks depends on the action of 1 of the 4 insulin doses:
-
the breakfast reading tells them how well the bedtime NPH from the night before is working
-
the lunch reading shows how well the breakfast Humalog insulin is working
-
the supper reading reflects the action of the breakfast NPH
-
the bedtime reading tells them if the supper Humalog insulin is working
These guidelines may seem a little simple, but they’re a good starting point for Jane and her family when her blood checks
are off target. For example, when Jane woke up with high readings 3 mornings in a row, her parents knew she needed more NPH
(intermediate-acting) insulin at night.
