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October 30, 2004

Hyperglycemia and DKA, Insulin Pumps

Question from Newportville, Pennsylvania:

My son has had type 1 diabetes for five years. I am very concerned about his blood sugars. They are high often and he can't explain why. I do think he doesn't always comply as far as getting daily exercise and sometimes he does eat what he shouldn't. He is going through adolescence and his endocrinologist said that it's not unusual for males to start resisting insulin. But, they also said that he is on enough insulin for his height, weight, and age. He hasn't been able to get the pump because the endocrinologist wants his A1c to come down. I am very concerned about him and this has been going on for some time. Do you have any suggestions?

Answer:

Managing diabetes in an adolescent can be very difficult. Be aware that on occasion, kids can misrepresent their blood sugars, how much insulin they are giving, and various other parts of their diabetes care that you are expecting — that they aren’t necessarily complying with. Most of the time this is not done maliciously, but is done out of frustration from dealing with their diabetes for many years. I encourage families that are struggling to make sure to positively reinforce good diabetes behaviors including testing frequently, taking insulin without having to be reminded, making good food and activity choices. You may also wish to check the meter more frequently to make sure you are getting accurate information from your teen. Enlisting one of their school friends to give good positive reinforcement while away from home can also be helpful.

Also, a pump can be an excellent choice for a teen in this situation. Pumps that communicate with blood sugar meters and that can dose based on carbohydrates take on much of the work of diabetes care and can be a big relief to a child/teen that is struggling. I am not a fan of waiting for a “good A1c” in order to get a pump, after all, if the child/teen was able to achieve an excellent A1c by using shots alone, what is the point of getting a pump?

In any situation, please remember to offer positive reinforcement to your struggling teen. This is a very difficult time for them.

MSB