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February 22, 2007

Behavior, Blood Tests and Insulin Injections

Question from Egan, Minnesota, USA:

My 17-year-old daughter has had type 1 for three years. She has been injecting her Humalog pen through her shirt, sweater or pants leg for a while now. She states that it works for her and she plans to continue to do this even though I questioned its safety. What do you think? Is it a safety issue? Also, her A1c for the past year has been 7.8, I know it should be below 7.0 and she was given some suggestions from her doctor on how to lower it. I know she could do this, but she does all of her own diabetes care and chooses not to follow these suggestions. Should I find a way to force her to do better at her diabetes care (always take her Humalog before meals, count her carbohydrates more accurately, test two hours after a meal to see if she's getting enough insulin)? I think the only way, at this point, to get her to want to lower her A1c would be to discuss complications. She knows about the possibility, but, as a teenager, I am sure she thinks this won't happen to her. Also, I don't want to depress her or scare her. She is doing a good job and handling it well, but is an A1c of 7.8 good enough? As she matures, I am hoping she will want to do this for her health.

Answer:

Giving an injection through clothing is not recommended. It is not sterile. Conceivably, one could get a “plug” of fibers injected under the skin which could cause a local reaction.

Nevertheless, I am unaware of any major problems with this practice and I think patients giving insulin do this more frequently than they admit.

DS
Additional comments from Dr. Jill Weissberg-Benchell:

There really is no way to “force” a teenager to take better care of themselves. If you try, then the battle becomes one between you and your child, instead of the two of you working together to manage this annoying and difficult disease called diabetes. Ask your daughter what things you might be able to do for her that would make her life easier. For example, does she want you to count carbohydrates for her and make recommendations regarding her doses when you are both together? Does she want you to down load her meter and examine trends to recommend insulin changes? Offering a partnership where she can assign you a helpful role may be a reasonable alternative to forcing her into changing her behavior. Moreover, discussing complications often scares and angers teenagers, but never changes their behavior. So, if your goal is to get her to be more vigilant in her diabetes care, a discussion about complications will not achieve that goal.

JWB