My son, who has had type 1 diabetes for eight years, has had some years where he is very controlled and some years where he was out of control (elevated glucose levels, DKA, and ketones). The past couple of years have been okay, except for moderately high A1c levels.

He started showing signs of fluctuating blood sugars which I addressed with his doctor who didn’t feel that a change was needed, but now my son has been passing ketones. I have tried doing the sliding scale under the team’s supervision, and sometimes we can control him, but sometimes we can’t. The shortest length of time he has went without passing ketones was seven hours, the longest was five days. Sometimes they are just ketones, but a few times he was in DKA.

I’m baffled and concerned. The doctors can’t seem to give me any answers other than this is a sign of no insulin. I would agree with this except that I know he is getting his shots. I don’t know the proper questions to ask to get results. I am extremely worried about this. Please give me some advice or direct me to the right source.

I can understand your concern about your son. Controlling blood sugar levels in an adolescent is a tough challenge and takes some time depending also on the partners (the patient with his/her family and the diabetes team… much better than his family doctor). I think you should try harder and sooner to get better metabolic control as is best judged by your son’s hemoglobin A1c). and absence of ketones.

To achieve this nowadays, the best therapeutic approach would be any basal/bolus insulin regimen. Quite recently, insulin pump therapy has spread among youngsters, but your family would need to have very close contact with a diabetes center comfortable in using the pump with adolescents.

Nevertheless, education is, by far, the most important thing in achieving good metabolic control, and it seems you might need some more. It’s not the professionals on your son’s diabetes team who should manage diabetes; it’s the patient with his/her family who must be educated on how to best manage it. To this aim, our website can make the difference through its easy and fast access to news and information regarding diabetes and its management. It can help you keep up-to-date through our answers to various questions and topics.

As your son grows up, he will be gradually able to take more responsibility with self-monitoring and self-management. This will be helpful for better metabolic control. Last but not least, soon there will be new devices and therapeutic opportunities that will make the lives of children with diabetes easier and safer.

MS