My nephew was diagnosed with type 1 diabetes about two years ago and now uses an insulin pump. His blood sugar levels stay consistently high, often 200 mg/dl [11.1 mmol/L] to 300 mg/dl [16.7 mmol/L] and sometimes over 400 mg/dl [22.2 mmol/L]. He was hospitalized in DKA recently. He was stabilized and they adjusted his rates, but his blood sugar levels continue to be consistently high. If you are doing everything right diet wise and using the pump correctly, shouldn’t his levels be under control by now? Are there some people that have this much trouble getting their levels at a “good” range? They keep changing his rates, but he still doesn’t have normal ranges, I’m concerned this will cause him damage if it goes on for long. He is not due back to his doctor until January.

Your intuition is exactly correct: IF he is following his diet correctly, and IF he is using his pump optimally and correctly, and IF he engages in “‘some”‘ regular physical activity, your nephew SHOULD be in much, much better control that you describe. And, if his glucoses are elevated like this, he is at significantly high risk for diabetes-related complications including, but not limited to, blindness, kidney damage, nerve damage, impotence, heart disease, strokes, etc.

While there may be very rare situations where there is significant resistance to insulin in a patient with type 1 diabetes, this can be tested for very easily: put the patient in the hospital and set the pump doses for what you think is “proper,” and have the nursing staff in control of all the doses for meals, etc. If the glucose levels are good in the hospital, then it strongly indicates that when the patient is HOME, he is not following proper measures.

By far and away, the most common reason for a child with diabetes to fail in the manner you describe is lack of appropriate meal planning, insulin dosing, and lack of “corrections.” Your doctor can get an idea about this by reviewing the pump use history in the pump computer. Similarly, it very often means that the child is NOT getting adequate ADULT supervision regarding their pump: too much autonomy is given (understandably) to the child.

DS