Most children need at least two or three injections of insulin each day, usually short- and intermediate-acting. The dosing schedule will be prescribed by the physician and will be adjusted frequently as your child progresses through the four stages of Type I diabetes. In general though, children do best on a morning mixed dose of short- and intermediate-acting insulin a half hour before breakfast, a second injection of either a mixed dose or a dose of short-acting insulin a half hour before supper, and a third injection of intermediate-acting insulin at bedtime.
There are exceptions to this. For example, very young children who go to bed at six or seven in the evening usually can be controlled with a single mixed-dose injection in the morning.
The need to adjust the dose of insulin is based on blood glucose levels over a period of time, usually three days. An occasional high or low is nothing to be concerned about. It is most likely due to erratic eating or a change in the child’s amount of physical activity. If, however, you begin to see a clear pattern indicating a permanent change in blood glucose, you need to call the doctor, who may change the dose. This is nothing to worry about, but it is one more thing your child will have to learn and get used to: the fact that diabetes is a dynamic disease—one’s body responds to management in various ways depending on a number of external factors. Because children are such creatures of habit and routine, this “lesson” can be difficult and scary.
Meals and snacks should be eaten on a regular schedule, both to coordinate with the insulin and to teach the child good habits for the future. This is not as difficult as it seems. Breakfast is usually at the same time each school morning (weekend breakfasts can be delayed for a little while but no more than an hour), lunch at school is at a set time every day, and you are probably used to the family sitting down to supper at roughly the same time every evening. If this has not been the practice at your house, now would be a good time to begin the habit of family meals; they serve a far greater purpose than setting a routine for a diabetic child.
Change the way you do certain things in order to increase physical activity, for example, stop driving everywhere and start using your legs or bicycle, don’t sit for more than an hour at a time, go to other people’s offices instead of asking them to come to yours (it’ll make them feel more important, especially if you’re their boss). Make exercise part of your daily routine. If you think of it as something you just do every day, like shaving, brushing your teeth, or taking time to read the daily paper, you won’t have to think about it, and you’ll be less likely to moan and groan before gearing yourself up to do it.
