My 14 year old daughter has become very unstable over the last few months with blood sugars still ranging 17-30 mmol/L [306-540 mg/dl] and a hemoglobin A1c of 13.8%, and she has had three hospital admissions for ketoacidosis (blood sugar: 51.3 mmol/L [923 mg/dl]). As a last resort, she was given Humalog in the hope it would stabilise her condition, but to date this is not the case. Her condition seems to keep going down from bad to worse, yet no reason has yet been found for this happening. Any hints would be greatly appreciated.

Teens can be difficult to treat because of insulin resistance and the hormone changes of puberty. However, the most common reason for recurrent episodes of DKA [diabetic ketoacidosis] and uncontrolled diabetes like this is omitted insulin.

You should talk with your daughter’s diabetes doctor and nurse and see if they think this is a possibility. Direct supervision of all insulin injections and all blood glucose testing, done four to five times per day usually stops the problem, in our experience.

SB
Additional comments from Stephanie Schwartz, diabetes nurse specialist:

It is actually better to actually do all the blood checks and give all the injections because teens are very adept at seemingly performing these tasks, while, in reality, they are not.

SS