November 19, 2003
Daily Care
Question from Belleville, Illinois, USA:
My 19-year-old son has had diabetes since he was seven years old. Here of late, his glucose levels have been very unstable. Running high. He used to eat like three grown men but he is naturally very thin. His appetite has dropped and he doesn’t eat half as much and his sugar levels have elevated, he has headaches, stomach aches and no energy. He is on Lantus at nite and a sliding scale of Humalog with meals. Normally, I used to be able to get his levels down and and in control, but here of late I feel totally helpless! His doctor has increased his Lantus to 40 units from 28! My son feels like “walking” insulin. He’s down to around 103 lbs (normally he’s only around 110). Is there anything different he can do in your opinion with his insulin dosages? Is this normal for a 19-year-old to go through? Will all that Lantus hurt him? I love my son and want him to live a long healthy life. I’ve prayed. Please shed some new light on this situation if you can. He’s had some of the best specialist in the past but no one has accomplished enough for me, this is my son.
Answer:
I hear your pain in your request. The teen years are very difficult to experience with a child with type 1 diabetes. This is a period of time when the child assumes all the responsibilities of self-care. As much as you would like, you cannot make him do everything you would do.
There are a lot of questions I have about what is happening with his self-care. Why is he having high sugars? Is he compliant with his insulin regimen? It sounds as though he is losing weight and having poor glucose control. The reason is not clear. Is he successfully negotiating the process of matching his food with appropriate insulin? Is he counting carbohydrates? This may help him to match the insulin with the food he eats. Does he have gastroparesis, a form of neuropathy where the stomach does not empty appropriately? Is he exercising as much as he needs to be or was before? Exercise decreases insulin requirements. These issues need to be discussed with his physician managing his diabetes. I did not see a hemoglobin A1C value for him. This is the best measure of overall blood sugar control.
JTL