Diabetes Management

I wanted to write about several pediatric cases but things got ridiculous tonight on call (blog coming up) and now I'm home late. We often admit children with diabetes to the inpatient service for diabetes teaching and optimizing an insulin regimen. The diabetes teaching is great; it's like school. They have special educators come for several hours to explain the pathophysiology, the carb counting, the symptoms of hyper and hypoglycemia, etc. But we had one patient in particular who was interesting. She presented with mild diabetic ketoacidosis, a life-threatening complication of diabetes, and went to the intensive care unit for intravenous insulin. She was quickly stabilized and transferred to the floor where she was started on a long acting insulin (glargine) and a short acting one for meals (aspart). Several hours later, she developed hives. What do you do with a diabetic who is allergic to insulin? I'm not sure what the outcome was; we got an allergy consult and tried to tease out whether she was allergic to one of the preservatives or other ingredients in the insulin formulations. Such questions are so fascinating and so strange.