I am 13 years old and we are using 70/30 for morning and evening and Regular if over 200, 2 shots a day. I am using a general practioner for a doctor. We don’t have a diabetic educator or specialist in our area. I am having blood sugars that are averaging okay except at evening before meal — I am always around 250. Should I be using different insulins yet at my age? I was diagnosed 5 months ago. We are looking for any information to talk to our doctor to change if need be. The closest educator or specialist is 5 hours away.

If your evening blood sugars are running around 250 mg/dl and you are mostly using the 30/70 mixture of Regular and NPH insulin then I think that you would certainly benefit from a visit to a center where there is a team with as nurse educator, a dietitan, and other members of a diabetes team. You don’t tell us if you have had hemoglobin A1c tests, which are a good measure of your average blood sugar over the last three months; but if they have been running at a level greater than 1% beyond the upper limit of normal for the method used that would enhance the argument for center care.

At 13 you should be considering some of the insulins and insulin regimens that make it easier to maintain excellent control as you prepare to meet the needs of college and later life. A common one might be to take lispro, a fast acting insulin immediately after meals, when you can adjust the dose each time for the premeal blood sugar and for appetite, together with a long acting insulin like ultralente at bedtime. You might even want to consider changing to a pump. A five hour drive might seem a long way; but after settling down to any new regimen it might be that you only needed to visit the center again once a year especially if you could maintain telephone, e-mail, and/or fax contact.

DOB