My 13 year old daughter is going through puberty and is having difficulty controlling her blood sugar level, mainly for the past two weeks. Finally, at her monthly check-up with her doctor, he decided to hospitalize her for close monitoring. That was three days ago. So far, her blood sugar level remains in the 20s mmol/L [over 362 mg/dl] despite keeping to a strict diet and exercising regularly, which normally would have brought down her blood sugar level immediately. Her doctor has insisted on not increasing her insulin. Today was the first time she has been diagnosed with ketones. Is the puberty having this effect on her? Also, is it right for her doctor not to increase the insulin dose after 18 months with diabetes?

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It sounds to me that your daughter is emerging from her diabetes honeymoon, given the duration that she has had diabetes. If she is demonstrating the presence of ketones, this indicates that she is receiving insufficient insulin.

I am uncertain why your doctor seems reluctant to increase the insulin. Your letter suggests that your daughter does not see a pediatric endocrinologist. I am uncertain as to your ready access to such a professional, but you might ask for a referral or at least ask your general pediatrician to speak with one about your daughter.

In very broad terms, the amount of insulin a teen might require could be one unit or more per day for every kilogram that the person weighs. So, if your daughter, at age 13, weighs 50 kg, I might anticipate that her total daily insulin dose might approach 50 to 75 units.

DS