My 18-year-old daughter has had type 1 since the age of 6. She has gained weight over the past year. At our last doctor’s visit she was told she was not watching her food intake or exercising properly. (I can say she eats great for a teenager and exercises.) We were told she would have to find a new doctor since she turned 18. We did so, and the new doctor thinks it’s the Ultralente at high levels making her gain the weight. She takes 15u morning and night and 7 Lente at night with Humalog when she eats. Since she’s leaving for college next week, the new doctor wants to wait until she comes home at Christmas to change her dosage. Could he be right? She really like the freedom the Ultralente gives her (instead of NPH and having to eat at regular times).

I roughly agree, from what you report, with your new doctor when he says that Ultralente may keep high levels of insulin in your daughter’s blood making her more prone to fat storage even though is the caloric intake which matters in any form of overweight being the final weight the only true ‘judge’. Also, the previous doctor was again right in saying that her food intake and physical exercise must be not properly controlled even though she seems not to eat so much or exercise so little. Again, it is the weight which really matter when we look for tailored diet and/or exercise program. That’s our ‘gold standard’.

MS
Additional comments from Dr. Lebinger:

I agree that if she is gaining too much weight her total insulin dose is too much. If she is taking more insulin than she needs, she has to “eat up” to it to avoid low blood sugars. Although usually the total Ultralente dose (A.M. and P.M.) is not greater than about 60% at this age, there is tremendous variation in individual needs. If you find the Ultralente routine works well for her, I would suggest first just trying to modify that routine a little. You might need to change the distribution of A.M. and P.M. Ultralentes (some people do better on more equal amounts in A.M. and P.M.), you might need to give less Humalog with meals, or even mix Humalog with Regular. Whatever you do, to stop the weight gain, she will need to take a little less insulin/day. Only trial and error and working with your child’s own doctor and dietitian will help you figure out what is best for your own daughter. Don’t make any changes without working with your daughter’s own physician.

TGL