My active, healthy 15 year old son is an who has had diabetes for four years and has been using a pump for the last year and a half, has had good control. He is 5 feet 7 inches tall, weighs 150 pounds, and his insulin intake is usually above 100 units/day with a midday basal rate of 3.9 units per hour. I am concerned about insulin resistance and wondering about the use of type 2 medications both to decrease the insulin intake and to stabilize his daily numbers. Could you give me info concerning the pluses and minuses of this approach?

There is only preliminary information about using drugs that decrease insulin resistance in the pubertal insulin resistance of type 1 diabetes. All the preliminary studies are promising. You should discuss this with your son’s diabetes team. There re excellent diabetes groups in Vancouver, for instance, who will know of this research. In fact, some was done in Toronto.

Metformin is the drug most studied and does not have major side effects. If he is obese, then working to decrease his obesity would be paramount with or without medications. Increasing daily exercise is also another great way to require less insulin even if there is insulin resistance. Sometimes, changing from one to another brand also is helpful and easy to try for a week or so to see if the doses change or not. The newer insulin sensitizers have not had much experience in this regard but also should work.

SB

[Editor’s comment: Although metformin (brand name: Glucophage) is usually safe, it does have frequent mild gastrointestinal side effects, and very rare life-threatening lactic acidosis.

WWQ]