Should I discontinue the night time long acting

[oman]

A month ago, my lovely 7 years old daughter was diagnosed as type 1 diabetes. She was admitted for 5 days to monitor her and to decide on the appropriate insulin dosage. Doctor decided on 2 injections a day, morning injection mix of 2 units of Actrapid Short Acting and 5 units of  Insulatard  long-acting. Night time injection mix of
2 units of Actrapid Short Acting and 4 units of  Insulatard  long-acting and told us to monitor her and check blood sugar every 4 hours for 2 months. Also advised us on how to change the dosage when required.
After few days I noticed that her morning sugar is getting low (upper 60

[JDRF Team SGG]

I, too, am a long-time type 1 diabetic woman. I agree that you should immediately call your daughter's doctor and ask about removing the long-lasting insulin for a period of time. Since she is newly diagnose, she may be going through what is commonly called the "honeymoon phase" whereby her pancreas still makes a little insulin. If this is true, she may bear watching as later on her blood sugars may start to rise as her pancreas quits working entirely. I can state first-hand that waking up with a blood sugar of 60 makes it very hard to climb out of bed. It may be hard to rouse her when she is slightly low like this, and I would encourage you to bring her a small glass of juice before trying to get her out of bed. She will feel better within a few minutes and be much happier. New research indicates that it is very important to treat lows as quickly as possible so that the brain doesn't have a chance to tell the live that it needs emergency sugars. So instead of taking her immediately to the breakfast table and feeding her (foods take longer to digest and bring sugar levels up than juice), it is important to give her a quick carbohydrate like juice first. Blood sugars in the low 70s can cause a person to feel very tired, also, although the upper 70's seem to not make a person feel bad. So you are on a fairly narrow tightrope. Do check back in with us. A lot of us have been where you are or where your daughter is.

[JDRF-Team-LRS]

Diabetes is heart-wrenching for parents.  As you've noted, it can be a dangerously fine line between good-control and dropping too low.

None of us here is a medical doctor, but all of us have extensive personal experience as a diabetic or caregiver.  It seems to me that you should call your daughter's doctor right away to discuss this situation.  And, I'd encourage you to get comfy calling the doc whenever your "mental alarms" start going off.  A good endocrinologist can help you sleep much better!  You (AND your daughter) need you to be well rested!

When you talk to your daughter's doctor, ask also about using Lantus insulin -- it is a long-acting insulin without a "peak."  For many diabetics, Lantus once or twice a day works well with a rapid or short acting insulin to cover meals.

One disadvantage (which may be why your daughter's doc has not suggested it) is that Lantus CANNOT be mixed with another insulin in the same syringe.  

In any event, the questions you ask are the right questions and they should be answered by your daughter's doc.  It is good if you can find a pediatric endocrinologist -- someone who specializes in the care of children with diabetes.  

I'm sure that others'll chime in here, so do check back in.  And please let us all know how your little one is doing.  

[JDRF-Team-dm]

Dear oman,

Thank you for contacting JDRF with your question.

Since I am a volunteer and not a physician, I would recommend discussing any medication changes with her doctor.  I know it can take awhile to get the dosages adjusted.

My son was diagnosed at 8 years old and your post sent me back 19 years.  I completely understand the sleepless nights, especially after only one month.  There is so much to learn in such a short period of time.  For me it was quite overwhelming.  I apologize for not being in a position to answer your specific question directly. Please know that you are not alone and we will help in anyway that we can. Support helped me so much, knowing there are alot of other parents going through the same thing.

Please keep in touch and let us know how you and your daughter are doing.

Best Wishes,
dm