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January 14, 2007

Behavior, Hyperglycemia and DKA

Question from Wyoming, USA:

My 17-year-old daughter has had type 1 diabetes since the age of three. She has been on an insulin pump for nine years. She’s a straight “A” student, very active in dance, and respected in her community. Her blood sugars are good in the mornings (60 mg/dl [3.3 mmol/L] to 100 mg/dl [5.6 mmol/L]), but high during the days (300 mg/dl [16.7 mmol/L] to 600 mg/dl [33.3 mmol/L]). She has been consistently high for weeks. Her last A1c, two months ago, was 10.8.

She doesn’t seem to have the time or concern to take care of her diabetes properly right now. She doesn’t want to talk to a nurse educator. I feel that she is just tired of having diabetes and wants to ignore it and be a “normal” teen. We, her parents, are tired of it, too. How much should we continue to do as parents and when should we back off? Of course, we are worried about complications. Do you have any suggestions?


From: DTeam Staff

Your daughter sounds like a responsible, delightful and bright young lady. You state that she is on an insulin pump and that her morning blood sugars are fine, but that her afternoons are rather high and that her A1c is getting higher. I wonder if she maintains her basal rate, but keeps forgetting to bolus after she eats. This is a fairly common issue and one that requires a team approach to solve. This means helping your daughter enlist the help of her parents and her diabetes care providers to figure out ways to remember to bolus. Also, the correct dose of insulin cannot be determined if she does not check blood sugars before each meal and before bedtime. Although it would be wonderful if she could throw all of her diabetes supplies away and just be “normal,” that is not the reality of her life. She needs to get the appropriate amount of insulin every day to be sure diabetes does not prevent her from doing the “normal” things all of her peers do. I’d encourage you to schedule the diabetes team appointment for her and then have everyone in the family go with her to that appointment, so she understands that everyone is there to help her through this frustrating time. Some families also find it helpful to have the adults take over all blood sugar checking for their child or teenager for at least a few weeks, if not much longer, so that this particular task of diabetes care is completed as frequently as necessary. Then, your daughter will only be responsible for the bolus after each meal, and it’s likely that an adult in the home can even do that for her when the meals are shared as a family.


[Editor’s comment: You might want to discuss two options with your daughter’s diabetes team: adding a shot or two of Lantus or Levemir to your daughter’s regimen or increasing her daytime basal rates to cover the foods she is eating during the day. You might even find that a combination of both options provides the best control.