My 13-year-old granddaughter spends time with me often. I don’t understand diabetes very well and must depend on her knowledge (she was diagnosed three years ago) or her father’s, but he hasn’t explained sufficiently. She has recently gone on the pump, but seems to be using too much insulin and can’t get her insulin refilled right now. My lack of understanding is in the way insulin effects her body if she’s using too much to be given the amount she needs. In other words, why does it matter how many carbohydrates she consumes if the insulin takes care of it? I wonder if she’s being denied because Medicaid or other supplier is concerned about the cost. She’s always been told by her endocrinologist that she uses too much insulin, which sounds like she’s eating too many carbohydrates. But why does it matter? I don’t get it. She’s to go to a regular camp over the next week and now has to contend with giving herself the shots. I just need to understand what’s bad about taking a lot of insulin if it’s needed to take care of the carbohydrates.

Great question. The key to overeating if producing your own insulin or, as in this example, taking too much by injections or pump equals excess weight gain. In addition, excess food intake, especially high fat carbohydrates, requires slower insulin boluses (something called square or dual or extended bolus delivery) so that the high fat which slows down the carbohydrate intake and raises the blood glucose levels aren’t balanced with the fast acting insulin boluses. When the insulin is slowed down, it then peaks 2 to 4 hours after the high fat carbohydrates and balances these effects; if not done, then the fast acting insulin peaks too early and completely misses the 2 to 4 hour peaks: hypoglycemia occurs the first 1 to 2 hours when insulin is working and no food has been absorbed, followed by insufficient insulin at 2 to 4 hours and hyperglycemia for 2 to 6 hours afterwards. The best books for you to read: Adam Brown’s Bright Spots, and Landmines, as well as Peter Chase and David Maahs’ Understanding Diabetes, 13th Edition, and Peter Chase and Laura Messer’s Understanding Insulin Pumps, Continuous Glucose Monitors and the Artificial Pancreas, 3rd Edition. Those will give you good information and help you better understand to provide better questions and discussions.

SB