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May 29, 2003


Question from Hamden, Connecticut, USA:

All of a sudden, my 14 year old son, who has type 1 diabetes, has a large appetite which I try to cover with more insulin, but his readings are still way out of whack. We had to move to three shots a day. I know he's going through puberty, but how long will we have these high readings? How much damage is it doing to him?


How long will his sugars be high? As long as the balance of insulin to food and activity is insufficient. Puberty typically lasts about four or so years, but the pubertal hormones (testosterone and estrogen) are now here to stay and are antagonistic to the effects of insulin. Commonly, before puberty, a child will require about 1 unit of insulin for every kilogram of their weight. With puberty and beyond, they may require about 1.5 units for every kilogram of body weight.

The damage? Well, if left unchecked for a cumulative effect of four to five years or more, you certainly may expect potential damage to the microvascular blood vessels, leading to vision, kidney, or nerve damage.

It is time to be in touch with your son’s diabetes team. Don’t fret about the number of shots he requires. In fact, your son’s diabetes team (or you and your child for that matter) may want to switch him to a more aggressive regimen of insulin called a basal/bolus plan whereby he would receive a dose of a long-lasting insulin but take a short-acting insulin, based on carbohydrate counting at meals, with every meal or snack. This is the same plan behind using an insulin pump. Be aggressive now!

One more note: as our children become teenagers, we want (and they act like they want) more independence from us as parents, but unfortunately, some teens with diabetes actually require increased parental vigilance at this time. Work with your teen and be a team player!

Additional comments from Dr. Larry Deeb:
14-year-old boys like to eat, and do for the next decade of life — or the next 5 years for sure. He likely needs meal and snack based insulin. I give rapid-acting insulin whenever 30 grams of carbs are eaten, and even then sometimes it is hard to keep up. This will likely mean insulin morning, lunch, afternoon snack and supper, and maybe even a bedtime dose if the meal is big enough.
It sounds like a lot, but it’s the best way, unless you use a pump.