September 9, 2002
Hyperglycemia and DKA
Question from Salt Lake City, Utah, USA:
My teenaged daughter, diagnosed three years ago, has always had consistently high blood sugars (350-600 mg/dl [19.4-33.3 mmol/L]) and usually has hemoglobin A1c levels in double digits. She was hospitalized this year to try and bring the numbers down, and we have tried everything (pens, every different kind of insulin, longer needles, etc.). She went on an insulin pump two weeks ago and right now her 24-hour total basal rate amount is 26.4 units along with her boluses.
Over the last year, she has had some weight gain, not a large amount, but it seems to be concentrated in her tummy. I just had her tested for celiac disease and she was negative. She seems to have several of the type 2 symptoms (high cholesterol), and right now my main concern is that she seems to be extremely insulin resistant. Is it possible for a person to have both type 1 and type 2 diabetes at the same time?
Answer:
It is true that one can develop insulin resistance (a hallmark of type 2 diabetes) after you’ve had type 1 diabetes, usually for a long time. More typically, this is noticed when older adolescents are taking very large amounts of insulin.
This is a difficult situation to handle and requires the expertise of a team experienced in treating diabetes in teenagers.
I would also be diligent about taking a bolus of Humalog with every meal. So frequently, missed boluses can contribute to a child’s difficulty with control. I would suggest checking the pump each week and reviewing the bolus history to ensure that adequate boluses are being taken. Also, kids usually eat 4-5 times each day and the bolus history should reflect that.
MSB
[Editor’s comment: See a previous question.
SS]
