My 12 year old daughter was recently diagnosed with type 1 diabetes, and has had high blood sugar levels lately although she is keeping a tight schedule on everything and doing everything she needs to. Why is she having these high sugars?

I regret that you do not provide enough information on which to base anything concrete. Please talk with your daughter’s diabetes team. If she is not seen by a pediatric endocrinologist, do not hesitate to ask for a referral. Perhaps another referral to a Recognized Diabetes Education program would be even better. In general, the three major issues that influence blood glucose are food intake, insulin dosing, and activity. If you are seeing “higher” readings lately, I would suggest that you look carefully at who is drawing up and administering the insulin. Many times a simple little error is repeated accidentally — such as an incorrect insulin dose. You might want to give injections yourself for a week or so, if your child is doing this herself — and I don’t mean “watch her give her own shots” but specifically physically give her the injections yourself.

Look for subtle changes in activity. Has soccer season ended; is she less active? Change in the physical education opportunities at school?

Watch the meal planning. This may be the most common cause of higher glucose readings.

If the glucose levels are high, be sure to start checking for blood or urine ketones, per her endocrinologist’s recommendations (some prefer to start checking with a glucose more than 240 mg/dl [13.1 mmol/L], while others do not start checking until 300 mg/dl [16.7 mmol/L].

Finally, I emphasize to be certain to address your questions and concerns to your daughter’s diabetes team. Teenagers are notoriously prone to subtly (or not) be passive aggressive about diabetes management.

DS