My 19 year old son has type�1 diabetes and is on Humalog before meals based on carb counting with Lantus at night, which works for him. Yesterday, to my shock, my 18 year old daughter was diagnosed with type 1 diabetes (awaiting antibody test results) which I can’t understand because she is grossly overweight. She is a 1200 calorie diet and takes the same doses of Regular insulin with NPH at night every day without carb counting. Can this be type 1 diabetes? Doesn’t she need to match calories to carbs?

Irrespective of which type of diabetes your daughter has, something that the result of the antibody test will help to determine, she has two problems. The first is the control of the blood sugar, and the second the reduction of her BMI (Body Mass Index).

With regard to the first problem, I do not see why she is on an insulin pattern that is less precise than that of her brother. It suggests that she is being cared for by a different team, and certainly you should discuss why the Humalog and Lantus (insulin glargine) regimen with carbohydrate counting would not be equally appropriate for her with her doctor. The problem of weight control on the other hand seems easy but is, in fact, hugely difficult at this age. Simply issuing a 1200 calorie diet is almost never sufficient, and even the combined efforts of social worker, dietitian, and organisations like WeightWatchers have little sustained success in restricting caloric intake and encouraging exercise programs. Drugs like sibutramine are probably not advisable, nor at this stage would gastric surgery be indicated. Perhaps the best hope is that further research on two recently defined appetite controlling gastric hormones (PYY and Ghrelin) will give rise to more effective solutions.

DOB