In our family, there is a 14 year old who has had type 1 diabetes for the last three years and is on Actrapid at breakfast and lunch with Mixtard before dinner. However, being a child, it sometimes becomes difficult to restrain him from eating fast foods like pizza, burgers, etc., which result in increase of the sugar level in his urine. He is taking the required medicines as prescribed, but due to intake of fast foods, the sugar level keeps on increasing.

Keeping the above facts in mind, please advise us as to what to do to keep his sugar level in check. It will also be helpful if you can suggest me any name of a good doctor in India to refer for the above purpose.

You are asking for the answer to the question that paediatric diabetes teams toil daily to understand. All 14 year olds, wherever they are in the world, are tempted to fast foods and to living like their friends. This is normal behaviour. All that you can hope to achieve is reasonable compliance most of the time. Over-rigidity is usually counterproductive.

I recommend that you browse the previous questions on this site. This will at least reassure you that your relative is normal. I think the best way to find a good doctor is to approach the nearest university hospital and make enquiries.

KJR

[Editor’s comment: It seems to me that this young man needs a revamp in his insulin regimen. As Dr Robertson has said, his behavior is quite typical of teens and making him “live with diabetes” will only lead to more rebellion and frustration. What needs to be done is to develop a treatment plan that will make his diabetes “live with him.” By that I mean finding a program conducive to a teenager’s lifestyle.

In this day and age, there are many such regimens available which are based on carbohydrate counting, allowing insulin to be given on the basis of food eaten. These regimens include various basal/bolus plans or use of an insulin pump.

As Dr Robertson has suggested, this young man’s parents should find a diabetes program well-versed in dealing with teens. In addition to contacting the university hospital, I would urge them to query the Diabetic Association of India (127 M.G. Road, Maneckya Wadia Bldg, 1st Floor, M.G. Road Fort, Bombay 40000; Tel. 91-22/273813) for the names of appropriate facilities.

In addition, it is important that this man monitor blood sugars instead of urine sugars to see what is really happening with his control, and he needs to have a hemoglobin A1c checked every three months. If he does not already have one, please purchase a blood glucose meter and have him monitor at least before meals and bedtime snack. Some two-hour after meal values would also be helpful in devising an appropriate treatment plan.

SS]