My 13-year-old daughter would love to be able to eat only when hungry, rather than on a schedule. She takes Humalog and NPH in the morning, Humalog at dinner, and NPH at bedtime. She isn’t interested in a pump. I asked our primary care physician (we don’t see an endocrinologist any longer because of an insurance change), and she said she would probably need to continue eating according to a schedule rather than based on hunger. Any thoughts on this?

On the insulins that she is on, eating on a schedule provides the best control. There are other insulins that might allow her more freedom. You might try seeing a consultant in pediatric endocrinology for some help. Some food could be reduced if her current insulin dose were reduced. All of these solutions take some carful guidance from health care professionals. I hope you can locate some help in your area.

JM
Additional comments from Dr. Quick:

Teenagers will need more flexibility in meal planning. Politely request a consultation with an endocrinologist and a dietitian who are experienced in helping teenagers. If your doc says no, then appeal the decision to the insurance company’s Case Managers or Medical Director.

WWQ

[Editor’s comment: You might find that using Ultralente as a basal, instead of NPH, with Humalog before each meal might help provide the flexibility your daughter is looking for. Some people call that insulin regimen the “poor man’s pump.”

JSH]