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February 28, 2012

Behavior, Other

Question from Yorba Linda, California, USA:

My 12-year-old son has had type 1 diabetes for four years. He also has ADHD. His A1c went from 6.7 one year ago to 7.9 most recently. I make frequent adjustments to his basal and bolus regimen based on blood glucose trends. The challenge I have is that when he snacks, he "forgets" to put in his carbohydrates. This is a frequent occurrence. Are there some ways to use his pump, his iPod or other tools to assist him in remembering to put in his carbohydrates? The more independent he is becoming, the more this is becoming a concern.

Answer:

I used to try to compensate by adjusting the basal. I have even given basals that were a total replacement for a standard lunch. Guess what? The occasional missed lunch led to a couple of serious lows. So, I am now a bit reluctant to do that.

I have seen patients come to me on unbelievable basal rates. They are at the edge of hypoglycemia in the morning and then higher all day, then return to a “good” level the next morning. Again, hypoglycemia is a great risk.

Be sure to take a good look at the basals. Puberty does increase the total insulin need and you do want to be on top of that.

It is about bolusing. Work on a reward system with your team.

LD