As children grow, their appetites and activity levels change. Their need for insulin also changes. You should not have to wait for a regular appointment with someone on the diabetes team to respond to these changes. Studies show that parents and children who actively take part in diabetes management are the most successful in adapting to the disease.
Remember, if your child needs more insulin or more injections, it does not mean their diabetes is getting worse. In the same way, if your child needs less insulin it does not mean the diabetes is going away.
Why change insulin requirements?
Adjusting insulin to the body’s current demands is simply a way of maintaining good balance and achieving better blood sugar control. For example, a heavier child might need more insulin than a smaller child. A child who is always on the go might need less insulin than a child who is not active. A teenager will likely need more insulin during puberty after the growth spurt. Or else an adolescent might require more insulin during exam week to balance the increased stress.
To make insulin adjustments on their own, parents (and teens who are managing their own insulin) must:
- Be confident that blood sugar checks are correct and meal plans are being followed (with no secret snacking or skipped meals).
- Know the child’s blood sugar target range.
- Understand the types of insulin being used and their action times.
- Understand what each blood sugar check means.
- Know when to contact the healthcare team.
When to make adjustments in insulin requirements
People with diabetes know when a 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 your child needs more insulin. Repeated low readings usually mean that your child needs less insulin.
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 hypoglycemia or hyperglycemia.
- The urine does not contain ketones.
- Seven to eight out of every 10 of the blood sugar checks are within the target range.
With any insulin regimen—whether two, three, or four injections a day—it is important to know which insulin is acting when, and which insulin dose needs to be adjusted when sugar levels are either too high or too low.
Understanding insulin readings: Jane’s story
Jane is a 10-year-old girl who has had diabetes for five years. She received NPH (intermediate-acting) and Humalog (rapid-acting) insulin before breakfast, Humalog at dinner, and NPH at bedtime. Jane’s family has learned that each of the four daily blood checks depends on the action of one of the four insulin doses.
- The pre-breakfast reading tells them how well the bedtime NPH from the night before is working.
- The pre-lunch reading shows how well the breakfast Humalog is working.
- The pre-dinner reading reflects the action of the breakfast NPH.
- The pre-bedtime reading tells them if the dinner Humalog is working.
These guidelines may seem a little simple, but they are 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 three mornings in a row, her parents knew she needed more NPH (intermediate-acting) insulin at night.
Tracking patterns
The goal of any insulin regimen is to keep blood sugar levels steady. The insulin dose should be changed only when a pattern or trend of off-target blood sugar levels appears.
For example, when blood sugar level is high at the same time of day for three days in a row, this is a pattern. Another pattern might be when blood sugar level is low at the same time of day more than two days in a row or more than three days a week.
As long as your child is feeling well, and does not have ketones in their urine, wait to adjust the insulin dose until the blood sugar checks have been outside the target range:
- three times in a row for highs at the same time of day
- twice in a row for lows at the same time of day.
There might be a good reason for these highs and lows, such as unplanned exercise or eating a meal you did not prepare yourself (often restaurant or store-bought meals have hidden sugars). In such cases, wait a while longer before adjusting the dose to see if the pattern lasts.
You should also check your child’s urine or blood for ketones if blood sugar levels are above 14 mmol/L for three readings in a row. If ketones are present, you may need to adjust your child’s insulin immediately; in these cases, contact your diabetes team.
Keeping a log book
The best way to keep track of changing insulin dosages and blood sugar readings is to write them down.