March 1, 2001
Daily Care
Question from :
My 14 year old daughter has had type�1 diabetes for a year and a half. It seems as if her blood sugars vary greatly day to day despite the NPH I give her. One day the level will be low, and the next day her blood sugars can be high even if she has had a lot of exercise. There are days when she’s 300 mg/dl [16.7 mmol/L] after a basketball game and other days she’s 60 mg/dl [3.3 mmol/L] before dinner with no sports. How can you possibly modify the NPH when half the time you can’t predict what her outcome will be? She’s on a sliding scale of Regular or Humalog too. Sometimes, it will lower her too much, and, at other times, it doesn’t seem to affect her blood sugar too much. Her meter gives varied blood sugars at times. You can do it one time and it’s 60 mg/dl [3.3 mmol/L] and she’ll say “I don’t feel low.” I tell her to do it again and it could be 230 mg/dl [12.8 mmol/L]. So you wind up doing it a third time to try to get the best out of three.
I hope and pray the islet cell transplants becomes available to her in the next few years. What do the insulin producers think about a future cure? Could they possibly be for it? Or do they hope secretly that it somehow fails? With the way politics work, who knows what kind of sabotage is out there. I shudder to think. All I know is my daughter has to deal with this every day and it breaks my heart that all I can do is try to manage the disease.
Answer:
It sounds like you are very frustrated. I don’t think there is a conspiracy against you or your daughter or any of the other folks around the world who have diabetes. In fact, the diabetes pharmaceutical companies are among the best of the pharmaceutical companies since they not only do a huge amount of research, but also support organizations like the American Diabetes Association, ISPAD, Juvenile Diabetes Research Foundation, EASD, and IDF.
I would suggest that you make an appointment with your daughter’s diabetes team and ask them these same questions. They could give you some very specific answers and, I suspect, help with some of the day to day frustrations of bouncy diabetes, problems with meters, readings, etc. Usually this indicates a mismatch between the insulin being provided, food and activity. Some times a change to a multidose insulin regimen with Humalog before meals and overlapping doses of NPH helps. Other times, Ultralente helps or an insulin pump may be the answer. However, problem solving with the diabetes team should help you and also your daughter to gain some more comfort and control of the situation.
SB
[Editor’s comment: It’s not clear from your letter whether your daughter is under the care of specialists or not. If not, ask for a referral to a diabetes team that is experienced in dealing with teenagers.
WWQ]