I’m a 15 year old girl with type 1 diabetes, diagnosed about four years ago. I would have my sugar normal most of the time, and I was dedicated. Later on, I went on the pump, and then I went off. Now, I always take my insulin shots twice a day, but because of my fear of fainting and the terrible feeling of having my sugar low, I can’t have my sugar normal. I always have it high (above 300 mg/dl [16.7 mmol/l]), and, if my sugar goes normal, I feel like it is low. I must admit I’ve gotten lazy, but it’s beyond my reach now. I have so much stress, and I don’t want to deal with my low sugar, especially in school now. How long can my body stand my horrible high blood sugars? Do you have any advice on how I can get back on track?

First of all, the feelings you have about your diabetes are normal for most adolescents with diabetes. Many kids go through a time where they have higher blood sugars and seem to get lazy about their diabetes as you suggest. It is important to know that every month you have a high average blood sugar (or hemoglobin A1C), you are adding risk to your future for developing the complications of diabetes including heart, nerve, blood vessel, kidney and eye disease. It is critical that you understand that risk and begin now to work toward more normal blood sugars. This can successfully be done in consultation with your diabetes team. When you are used to blood sugars averaging in the 300s mg/dl [16.7 mmol/l], a blood sugar of 100-150 mg/dl [5.6-8.3 mmol/l], may feel like a low blood sugar. However, as you gradually decrease your average blood sugar over many weeks, a blood sugar of 100-150 mg/dl [5.6-8.3 mmol/l] will not cause the typical symptoms of lows.

I would suggest talking at length with your diabetes team. They will be thrilled to hear that you are wishing to have better control and will fashion a plan that can best meet your needs. Improved control is not beyond your reach!

MSB

[Editor’s comment: Congratulations, it sounds like you’re ready to take control! I agree with Dr. Brown that what you have been through is quite typical of many teens.

Maybe, you’d like to consider starting over. By that I mean, going back on your insulin pump and taking time to learn all you can to make it work for you. The pump allows you a great deal of freedom and flexibility provided that you monitor carefully and learn how to adjust rates based on what you want to do.

Like Dr. Brown, I suggest that you have a visit with your diabetes team to explain where you were, where you are, and where you would like to be with regard to diabetes control. Then, you can all work together to develop a treatment plan based on your needs to optimize you control. It will take time, but with a positive attitude and a fresh beginning, you can do it!

SS]