Our three and a half year old daughter, diagnosed with type�1 diabetes at 12 months of age, recently started on an insulin pump, and we have noticed that the higher her blood sugar is, the more insulin she needs per point drop. We sometimes have to bolus several times when high before we get the desired reading. Her endocrinologist has suggested that this may have to do with insulin resistance at higher blood sugar readings. Can you elaborate on this?

Your daughter’s endocrinologist is right. You just need to recalculate better correction factors. It may be that she is legitimately rebounding — that is, once she gets a low blood sugar, her normal body response is to try to fix the low by sending out stress hormones including adrenaline, growth hormone, cortisone, etc. All this blocks whatever insulin you are giving or planning to give so that you need relatively more than would be the case just for some extra carbs in food or snacks. Also, your daughter’s basal rate may need to be adjusted upwards a bit so that the correction factors can work more efficiently. Do a lot of blood glucose readings and problem solve with your daughter’s diabetes team.

SB