Can you provide a rough estimate regarding the average amount of short-acting insulin and long-acting insulin that a 14 year old, 128 pound male, who is very active, might be taking once the honeymoon stage is over? What is the average of each and total daily combined insulin requirements? And how does one truly know, without any doubt, that the honeymoon stage is over? Should pre-diagnosis tests be requested again?

It is probably not so critically clinically important to predict or know when the diabetes honeymoon is over. But, experience will tell you based on home glucose monitoring. If, despite the “typical” doses of insulin, the glucose levels are persistently inadequate, then the honeymoon is probably over. If he has been on NPH and Regular (or Humalog/NovoLog), you will recognize when the honeymoon is over because the lunchtime and bedtime readings will be persistently higher.

There is no reason, clinically, to repeat many diagnostic tests.

In general terms, maintenance amounts of insulin approximate about 0.5-1.5 units per kilogram body weight per day. There are many things that influence this: attention to meal planning and exercise, which are perhaps the greatest influences. Pubertal status is also important, as is overall health and concurrent illness. Being pregnant influences insulin requirements. So, for a 128 pound (58 kilogram) 14 year old, who is a presumably pubertal male, you can expect a total daily insulin dose to be around 60 units, give or take. Of this, typically about 60% is the “basal” or longer lasting component and the remaining 40% relates to short-acting with meals. Keep in mind that these are ballpark figures and any individual patient may have different needs.

DS