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August 1, 2005

Daily Care, Insulin

Question from Faridabad, Haryana, India:

I have a query regarding my eight year old daughter who was diagnosed with type 1 in October 1999. She weighs 42 kg (92 pounds) currently. She has had a growth spurt every winter since diagnosis. She has picked up weight at a rate of three to four kilograms (six to eight pounds) every winter. Presently, she is on two injections a day, 35 units of Human Monotard (with Zinc Suspension) in the morning (6 a.m.) and a sliding scale of Actrapid based on her blood sugar (generally, one unit per 100 mg/dl [5.6 mmol/L] excess). In the evening, my daughter gets nine units of Monotard and Actrapid depending on her blood sugar. All of this amounts to at least 46 units of insulin per day. She has developed fat accumulation around her waist. We do our best to control her diet and carbohydrate/caloric intake, but are really struggling to get her weight under control. Not much of help is available from the doctors around here. We just get theoretical inputs in the form of diet charts (type 2 diabetes), which are really very tough to be followed by a child with type 1. Based on the knowledge I have acquired through tremendous reading on the subject and a very accurate and precise monitoring of weight, diet, exercise, insulin, metabolism, etc., I believe that my daughter has "insulin resistance." But, there is no test to prove this. I am seriously concerned about it and want to know if the insulin resistance could be minimized somehow. I want to reduce her insulin requirement.

Answer:

Given your daughter’s age and weight, a total daily dosage of 46 units of insulin a day of is physiologically understandable. I don’t see any sign of insulin resistance in your daughter’s clinical picture. I think her weight gain is related to her caloric intake. This phenomenon of abnormal weight gain is nowadays more and more common among adolescents with type 1 diabetes. With no information on her A1c average values, it’s difficult to judge, but I’d say that an intensified insulin regimen based on Lantus as basal and lispro (Humalog) or NovoLog before each meals might help towards a more physiological insulin substitution and probably a more physiological weight gain. Please be sure to discuss the use of these different insulins with your daughter’s diabetes team.

MS