November 2, 2006
Question from Algonquin, Illinois, USA:
What could be the cause of a lesser insulin requirement? My son was diagnosed with type 1 at age nine. He is now 17 and, in the last two weeks, he has had two seizures due to low blood sugar. We have changed his Lantus (given at bedtime) from 49 units to 38 units and one day he still went low. What could be some causes of his body to require less insulin? He also takes Humalog at meal times.
There are a number of things that could contribute to unanticipated enhanced sensitivity to insulin and, thus, less insulin requirements, including, for example, if there have been more activities, sometimes even subtle ones (change in routine at physical education class, new routine for track season, etc.). If food is not being absorbed because of smoldering gastroenteritis, one can get low glucoses for a bit, but it would be expected for the effect to be transient as the intestinal system heals.
An intestinal issue that has a near 8% incidence with type 1 diabetes is celiac disease, which impairs effective digestion and absorption of nutrients and thus can lead to a mismatch of insulin to “anticipated” absorbed calories. You can read other questions about Celiac and other information about Celiac on our web site.
Similarly, some other hormonal imbalances can occur or develop along with type 1 diabetes, such as thyroid and adrenal gland imbalances. Typically, too little thyroid hormone or too little adrenal cortisol can lead to enhanced insulin action and, thus, hypoglycemia.
These are a few common examples. You must confer with the child’s diabetes team to look for these and other concerns. In the meantime, keep checking glucose readings and have your fast-acting sugar and glucagon kits updated and at the ready.