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how close to eating should insulin be taken?
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how close to eating should insulin be taken?

My son is taking 30/70 novolin with an insulin pen twice a day. The specialist told him to take it half an hour before breakfast and dinner. Sometimes he takes the insulin and then eats immediately - is this OK? Is there some flexibility here in regards to the timing. Also he has had two low blood sugars in the middle of the night recently and I am wondering if it's because on those nights he didn't eat anything before going to bed.
I am completely new to all of this, so any comments would be much appreciated.
Sometimes my son will talk to me about his blood sugars and other times he wants it to be completely his business - He is at a very delicate stage in life where he is seeking independence and I want to respect this, but on the other hand I do worry about his diabetes. I think he checks his blood sugars about once or twice a day.
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Each insulin has a different onset time whereby it starts to lower the glucose levels in the bloodstream, and each type of insulin also has a different peak time where it does its greatest work. The IDEAL is for the onset to start at the same time as the beginning of digestion of food and the peak to occur at the same time as the main absorption of the carbs we eat. There are insulins that begin to act quicker than Novolin, and perhaps, if your son is happier taking his medication right before the meal (it may be easier to remember it when he is taking a break to eat anyway), it may be feasible to change to a quicker-acting insulin. You may want to speak to your son's endocrinologist about this.

If he is taking his insulin and then eating before the insulin begins to work, his glucose levels may be rising sharply before the insulni can begin to do its thing. The way to find out for sure would be to do a glucose test about 2 hours after the meal to see how much of a rise there was. Most endocrinologists like for their patients' glucose levels after meals to stay under 180. If the insulin onset time and digestion time are a good match, you should not be seeing huge spikes in glucose after meals, but the insulin should be covering the carbs as they are digested and absorbed.

Lows at night are a real danger... It is IMPERATIVE that he do a glucose check before he goes to bed at night. Also, I would heartily recommend many more glucose checks per day than 2 for good control and protection from complications in the future. If high, he should be able to KNOW it so he can take insulin to bring gluocse levels to normal, and if low, he should also be able to do a test and see how low he is getting and not rely on how he feels.

The ideal is at least a check before every meal and at bedtime, but people who manage their diabetes with the best control do glucose checks in between meals also so they know if their insuln and food matched up properly and can adjust any mistakes immediately rather than waiting until the next meal.

Having said all of this, I realize that your son is young (you didn't give his age, but I would guess he is at least 12 and possibly a teen if he is seeking independence). Most endocrinologists do NOT attempt to keep the optimum tight control on children and young teens becuase their activity levels vary so much that hypoglycemia is a real danger if glucose levels are kept too low. So your endocrinologist shoud be the person who gives you the goals to try to acheive at his age. The important thing in children is to keep them controlled enough to protect them from damages, and then when they get older, they can tighten up the numbers for more of a perfect control when they are mature enough to handle the increased risk of hypoglycemia that tight glucose control brings.

I was 12 years old when diagnosed, and I pretty much did all of my own testing and shots at that age. The diabetic child tends to feel "guilty" if a glucose test comes back wtih a high number, for we feel we have done something wrong. One young diabetic made a comment to me that this is a disease whereby the pancreas has been replaced by guilt! I would encourage you to instill in your son that normal gluocose numbers are not "good" and high or low numbers "bad", but that these numbers are merely neutral numbers that we use for information so we know how much insulin to take. In a non-diabetic person, the brain does this for us without any glucose tests needing to be made. A normal peson's glucose levels rise after a meal and the brain tells the body to produce more insulin. So the glucometer is merely offering this information for us. No guilt necessary. Just action to normalize the glucose.

It is great that your son is attempting to shoulder the responsibility for his care himself. However, the support of parents may be necessary to make sure he does not go into a denial phase as many young teens do and hurt himself by not taking medication properly or testng often enough. Especially when he begins to drive, there should be a rule that he never gets behind the wheel without doing a finger ***** and glucose test, for one hypoglycemic episode while driving can kill him if he has an accident because his abilty to judge distance or respond to stimuli is impaired. Each child is different, and the management of diabetes should become a team effort with your son growing in maturity and taking more and more of the responsibility for his own care as he grows up. It isn't easy, for many kids do resent their parents' involvement in their diabetes care during the teen years.

Please feel free to contact the Juvenile Diabetes Research Foundation's Online Diabetes Support Team if you would like to be matched up one-on-one with a parent of a diabetic child your son's age. This kind of relationship in on-line communication can be helpful as you both go through his teen years, for many have done it before you. You can contact them by going to www.jdrf.org and click on the "Life with Diabetes" link at the top of the page to find the page that offers online support. Also, as a new mom of  a diabetic child, you will find all sorts of information on this web site, so please do check it out. We wish both of you the best.
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