My 15-year-old daughter was diagnosed with type 1 diabetes 18 months ago. She is on insulin injections (two injections of Mixtard and one shot of Lantus). Although we did not change anything in her diet for a year, she continues to gain weight. She has gained 12 kg (24 pounds), 9 kg (20 pounds) of them in the past 18 months. What is the right way to make her stop gaining weight and allow her to lose some weight? She eats all meals at a specific time and they total about 1500 calories per day.

These certainly are issues that you should bring up to her own diabetes team.

The EASIEST way to control glucoses is by giving insulin. Meal planning certainly can help, but is harder to follow than simply giving a shot. Exercising, however, remains key. It is simple physics and math: If you eat 1500 calories and you burn off 1200 calories, you will have netted 300 calories and if occurs daily, thus gain weight. If you eat 1500 calories and you burn off 1700 calories, you will have lost 200 calories and, if consistent, thus with time, lose weight.

Speaking for my own Division, we are very good about instructing about insulin. We do stress meal planning and carbohydrate counting, etc. But we are not good about getting kids more active. If someone has the magic answer to that, the WORLD will be less obese.

DS