My 19 year old granddaughter (5 feet, approximately 97 pounds) is currently on only 8 units total of Ultralente insulin, her HbA1c is perfect (near normal), and she eats well (just rarely carbs). Is this not enough insulin? Why does she weigh under 100 pounds? She is not in the “honeymoon stage” anymore.

I don’t know if you should be worried. If her hemoglobin A1c shows as good control as you indicate and she is otherwise healthy and energetic, then it doesn’t generally matter how much insulin she receives, as long as her glucose levels are controlled, she is not ketotic, and she is otherwise well.

I will say that a total daily dose of insulin of only 8 units of Ultralente is not a lot for a 97 pound young adult. Doesn’t she receive other short acting insulin like Regular, Humalog, or Novolog with meals? Hopefully she is followed by a comprehensive diabetes team.

DS
Additional comments from Dr. Marco Songini:

I really understand your concern regarding granddaughter’s therapy and weight (which is surely underweight). Besides reviewing her lab work, I’d check now her for thyroid and celiac disease with a concurrent assessment of her meal planning with a dietitian involved in the care of young people who have type�1 diabetes. As a further step, you can talk to a psychologist to assess whether there is any suspicion of eating disorders. If there is, ask her doctor for a referral to a diabetes team with experience in adolescent eating disorders.

MS
Additional comments from Lois Schmidt Finney, diabetes dietitian:

If your granddaughter has very small bones, then 97 pounds is not out of line for her desired weight. Are her parents of average height? I assume she is menstruating since if so, that indicates that she has enough body fat to do so. For someone who is only 97 pounds, then 8 units of Ultralente (and I assume there must be some quick-acting insulin in about the same total amount is reasonable), but I understand your concern.

Is your granddaughter and her immediate family concerned about being small? Finally I wonder about saying she rarely eats carbs since that is not the recommendation of the American Diabetes Association, so your granddaughter should revisit her diabetes team — perhaps it is time for tune-up. Young people this age often are ready to stop seeing their pediatric team, but have not become involved with an adult diabetes team which makes things difficult.

LSF