August 12, 2003
Daily Care
Question from Marion, Indiana, USA:
Last year, my 16 year old niece, who has had type 1 for three years, was placed on Humalog and Lantus which allowed more freedom in her diet. However, she had terrible control and had several instances of hypoglycemia also. For the last six months, she has been on a stricter diet, but her A1c still runs 9-10%, and her blood sugars are all over the place. Her specialist hasn’t changed any of her insulin in this time frame either, and we are all frustrated that they don’t seem to be very concerned with her numbers. She checks her blood sugar four to five times daily and has made an honest effort to bring them under control. Is it acceptable for teenagers to be allowed to run this high?
Answer:
A hemoglobin A1c of 10% most likely comes from missed insulin. I expect the physician knows this and has chosen not to confront, or has and people are denying. After 25 years and lots of camps with kids with “impossible” diabetes, I have been impressed with the fact that strictly administered insulin works and works well to control glucose. I expect she is afraid of the hypos and won’t give enough insulin. We sometimes find ourselves pushing up the dose believing more insulin is needed when it is just “some” insulin. When the big dose is taken, a hypo results.
LD
