My daughter is 13 and has had type 1 diabetes for five years. She currently takes 80 units of Lantus at bedtime and Humalog with meals and snacks. She is about five feet tall and weighs around 107 pounds. She has always been short for her age and has never had a problem with weight gain. She is now constantly hungry since starting her period about two months ago. She is gaining weight a little at a time. Does increased insulin dosage cause excessive hunger? It seems we are constantly giving her Humalog because she is always eating. Her endocrinologist said that 80 units of Lantus was not too much for her to be taking and we needed to cover everything she puts into her mouth with Humalog. I am just very concerned about her constant hunger and gradual weight gain. Do you think this is due to her insulin intake or just a result of having diabetes? She is eating us out of house and home!

Not uncommonly, in a “run-of-the-mill” teenager with type 1 diabetes, one can estimate that daily insulin requirements are about one to one and a half units of insulin for every kilogram of body weight. The long-lasting, or basal, insulin requirements are typically about 40-60% of the total daily insulin. Certainly, many things can influence this, such as activities, other health considerations, and concomitant medications. If your daughter weighs 107 lbs (~49 kg), then her Lantus dose alone provides as much insulin as I would estimate that she needs. This does not even account for the fast-acting Humalog insulin for meals and snacks.

It is common to see that people who are “over-insulinized” have increased hunger and thus “feed the lows.” Insulin is a very potent “anabolic hormone” meaning it causes the accumulation of protein and fat and stored glucose. I would be rather suspicious that she is getting excessive insulin, not to the point of pushing the A1c down too far (although you did not give her HbA1c values), but that she is driving her appetite by having more low glucose than you might be aware.

I would suggest that you check some of the glucoses levels when she is “really hungry” and check some 2-4 a.m. glucose readings as well. Also, I think you might want to be sure that your pediatric endocrinologist recognizes the relative amount of Lantus to your daughter’s weight. Perhaps something is being overlooked. Finally, if your daughter likes this basal-bolus plan of Lantus with Humalog, does check glucose readings regularly, and can count carbohydrates well, she may find she will be an excellent candidate for an insulin pump.

DS
Additional comments from Dr. Larry Deeb:

Be sure you are not feeding lows. That is the major concern here as I see it.

LD