From Everett, Washington, USA:
My son has had Type 1 diabetes since the age of 3 1/2 years old; he is now 12. He has always been fairly easy to control until this last year. Now his numbers have been so high that on occasion we cannot get a reading. My question is can a child diabetic have such a drastic swing with the glucose that I might be missing the extreme low before he bounces back up way too high? We have been checking him 4 times a day but still sometimes I feel I am missing something. I have tried rearranging his schedule with insulin to 3 shots a day with 9 R and 17 L in the morning and then 5 R at dinner and then 9 L at bedtime. Now we have gone back to 9 R and 17 L in the morning; 5 R 9 L at dinner with the same high results as before. We have added more insulin and checked his diet for things he should not be eating. Could some of this just be his age too? He is a good kid and quite willing to help be responsible too, but these high numbers have me worried he will have more health problems in a few short years. Any ideas?
While it is not easy for me to make specific recommendations for your son without knowing, for instance, a little bit more about his home glucose monitoring profiles, I suggest that the puberty phase (at 12 years old your son is about, or already is, to be in that particular phase of growing) can be partially responsible for the recently observed dramatic and sudden changes. As a matter of fact, puberty hormones increase the insulin needs through a metabolic mechanism called insulin resistance and this makes teens resistant to insulin with higher doses per body weight required to achieve the desired metabolic effect.
Nevertheless, in puberty we observe a more gradual requirement for steadily increasing insulin doses than the rapid "unpredictable" swinges you report. Are there any infections? Are his injection sites healthy: lumpy sites can account for a lot of unpredictable absorption of injected insulin.
You should check with your son's diabetes team whether it could be appropriate to switch him towards a more flexible regimen such as the one of the basal-bolus programs. These generally works better in adolescents whose food patterns, exercise, sick days, etc., can make for quite a challenge to regulate their blood sugars over the days.
Remember that it's average metabolic control over time (as reflected by glycohemoglobin levels) that matters in term of future complications of the disease. We're seeing the glycohemoglobin levels decreasing more and more among our adolescent population as they're managing their diabetes on more flexible schemes and quite a good education.
Original posting 1 Apr 1998
Posted to Puberty
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Last Updated: Tuesday April 06, 2010 15:08:58
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