My 16 year old daughter has had A1c’s in the 11-14% range for almost two years, and her daily blood sugars reflect this. She takes quite a lot of daily insulin, totaling 50 units of Lente and perhaps 30 units of Humalog. We’ve steadily increased the insulin, but it seems to have no effect. Would it help at all to switch the Lente to NPH?

There may be other issues such as over-eating involved. She is always hungry, but she does seem to cover anything extra with Humalog. It almost seems as if the Lente is having no effect.

I don’t use much Lente myself, but others do very successfully. Anyway, I am not convinced changing to NPH will change the outcome. I expect there is just too much food. Is she amenable to trying a more controlled meal plan? Ask, and if so, arrange for her to meet with her dietitian.

Is she truly getting all the shots? Sometimes high hemoglobin A1c’s are a form of dieting. You can eat what you want and waste it all in the urine. I’ve even had kids deliberately lose weight this way.

While I’m not recommending it, the insulin pump is useful because you can see the basal rate and bolus data making it harder to skip with no one knowing. Even then, the teen says, “I forgot” and there isn’t much to be done about it.

The real message is to keep working and try some of these suggestions.

LD