August 21, 2001
Daily Care
Question from Melbourne, Australia:
My 15 year old son, who has had type�1 diabetes for two years, was recently diagnosed with first stage glomerulonephritis, and we have been told to bring his A1c levels below 7% to decrease the likelihood of kidney dialysis. At the moment, he is taking two shots a day of NPH with Humalog, and his dinner glucose reading is 10 mmol/L [180 mg/dl] which is the one we need to decrease to below 7 mmol/L [126 mg/dl] for better control. How?
My feeling is that his diet is okay. He plays field hockey twice a week, and has physical education at school. Will increasing his exercise help to bring the hemoglobin A1c reading down? Should we look at increasing insulin? I would rather not have him inject three times a day if it can be avoided.
Answer:
I sympathise with your problem and reluctance to move to more injections, but it seems that you don’t have any flexibility in your son’s current insulin regimen. 15 year olds simply don’t have very routine lives and need an insulin system that they can adjust according to activity, etc. I strongly advise that you speak to his diabetes team about all of the options with an open mind. I know that the Melbourne area has excellent paediatric diabetes input so you should be confident of the advice.
KJR