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February 9, 2004

Daily Care

Question from Chicago, Illinois, USA:

My 13 year old niece has type 1 diabetes. She has been using insulin since the diagnosis more than 2 years ago. The problem seems to be controlling her blood glucose levels. When we are together - which is not daily - she is reluctant to test, is usually high and frequently is allowed "special treats" that are high in sugar and carbs. I am concerned that neither she nor her parents are taking this disease seriously and do not realize the health risks she is suffering by not managing the glucose levels better. I don't know how to approach the family about this, and am concerned that their doctor is not more forceful with them regarding the treatment. My niece suffers headaches, stomach aches, mood swings, etc., which may be related to being 13 just as much as to having type 1 diabetes. Any thoughts? Am I worrying over nothing?

Answer:

I don’t think you are “worrying over nothing.” You are a caring relative and want to learn more. But I would need some additional information to make a better response. Primarily, my response might hinge on the type(s) of insulin that your niece receives. If she is on a “basal-bolus” insulin plan, then splurging extra carbohydrates may simply be covered by giving an extra, appropriate amount of insulin. A typical basal-bolus plan would generally involve the use of long-acting, non-peaking insulin such as Lantus and then a shot of very rapid-acting insulin, such as Humalog or NovoLog, with each meal and snack.

If she receives a more “fixed” dose of short and intermediate-acting insulins, such as NPH or Lente and Humalog/Regular, then she probably has snacks “built in” to the meal plan and she may not need to dose with extra insulin.

ALL careful diabetes regimens do require diligent testing and based on your letter, your niece is not doing that! You may take the initiative and under the genuine desire to best care for your niece when together, ask her parents for the name of the Certified Diabetes Education (CDE) Team that worked with them and see if they will allow you to attend some sessions. Those CDE professionals may not be able to share specific info about your niece with you without parental permission, but the girl’s parents may welcome additional help. The teenage years can be a challenge for any teen (and their parents!!) without the additional burden of a chronic illness such as diabetes. Her parents may jump at the chance for an another set of eyes, hands, and voice!

DS