“Our five-year-old daughter has type 1 diabetes. We’re a little confused about what to do when her blood sugar is 15 mmol/l at 10 p.m. Should we give her 0.5 Humalin R, or should we just check her blood sugar every two hours? In the morning at 7:00 a.m., her blood sugar is usually in the normal range, between 5.0 and 6.2 mmol/l. Thank you for your response.” — Reader Boštjan
We don’t usually provide this kind of advice online because children are much more challenging to manage, and insulin doses are very low compared to those for adults—which might bother some people. A dose of 0.5 E, for example, is simply impossible for adults who do not use an insulin pump. Regarding fluctuations, parents usually receive instructions for insulin doses with each meal. If blood sugar is high in the evening, it’s much more likely that it was caused by a certain type of dinner (dairy or fruit-based) that raised blood sugar. In principle, of course, you can adjust the blood sugar level by up to 0.5 E, and then check blood sugar again after two hours. However, this is not for the purpose of preventing hypoglycemia. I suggest you instead try monitoring your evening meals by measuring your blood sugar at the same time every day—for example, one and a half hours after a meal. This way, you’ll be able to determine if certain dinners happen to be unsuitable for blood sugar levels and require an adjustment to the insulin dose. Otherwise, the current dose is likely appropriate. The key difference is whether the child eats something protein-rich or vegetable-based, or, conversely, just some fruit or a dairy product. If, during the monitoring described above, you notice meals that consistently cause blood sugar to spike too high, discuss this with your child’s pediatrician at the next checkup so they can adjust the treatment plan accordingly.