My daughter has had type 1 diabetes since she was three. She takes 16 units of Lantus at bedtime and a sliding scale of Humalog. She has a friend visiting from out of state and her activity level has increased. Therefore, her numbers are really good, 143 to 196 mg/dl [7.9 to 10.9 mmol/L]. Are her chances of DKA increased because I know she isn’t getting her usual amount of insulin? When her sugar is 155 mg/dl [8.6 mmol/L], she will only get six units. She gets four shots of Humalog for breakfast, lunch, dinner, and snack.

No, her chances of diabetic ketoacidosis (DKA) are not increased with lower insulin requirements. Her insulin requirements are her required amount of insulin. This means that with a balance of caloric intake, physical activity, and insulin, she is clearly keeping her glucose levels in check. If she becomes less active once again, you would expect this three-pronged balance to be disrupted, thus leading to the need also to decrease caloric intake or increase the insulin to keep things in balance. Typically, I wouldn’t force food restriction (but would push for good food choices), as this could lead to an eating disorder. So increasing the insulin would likely then be required.

But, I think a real important take home message to you and other readers is that: IT DOES NOT TAKE MUCH INCREASED ACTIVITY TO IMPACT DIABETES CONTROL, so, do not overlook the importance of physical activity. I have many parents who were absolutely stunned when their child required so much less insulin while at diabetes camp, for example!

DS