February 22, 2006
Question from Phoenix, Arizona, USA:
I am inquiring about when to be concerned about "insulin resistance." I have been reading many inquiries and postings that say that kids are requiring too much insulin. How much insulin is "too much?" My teenager is in a big growth spurt and requires 60 to 90 units per day of NovoLog via a pump. Is this because he is eating too many carbohydrates or because he is miscalculating carbohydrates and having to give correction boluses? Sometimes, we even hit 100 units of insulin per day. We think we are calculating carbohydrates correctly, so, what is the acceptable amount of insulin per day that one should have before we think it falls into the category of "insulin resistance?" What defines "insulin resistance"?
All teenagers, by definition, because of their hormone surges, mostly growth hormone but also other hormones, need more insulin than at other times of life. The more they eat, the more insulin they need, so, this is an additional factor. The more obesity, the more insulin needed for the fat cells requirements. All of these factors are in play with adolescents. Doses of insulin are calculated on a weight/kilogram/day basis. Values more than 1.5 units/kilogram/day are considered very high. The more carbohydrates, the more likely that more insulin is needed. But, all of this is highly individualized so you should discuss this questions directly with your diabetes team so that they can give specific advice.