July 12, 2008
Behavior, Daily Care
Question from Lawrenceville, New Jersey, USA:
My 19-year-old son has had type 1 diabetes for two and a half years. He was sent home from the hospital on a Medtronic insulin pump and has used one ever since. His control is excellent with an A1C ranging from 5.2 to 5.7. It has NEVER been higher than 5.7. Nevertheless, he is sloppy with his care. He eats whatever he wants and covers whatever he eats by bolusing. He doesn’t like carrying his meter with him and leaves it home half the time. He checks his sugars two to four times per day. So, has he been plain lucky to have such good numbers? He had one visit with a different endocrinologist who said that some people (particularly when diagnosed in the late teen years) run a milder course with this illness. Is this true?
In addition, he NEVER exercises. In fact, he refuses to exercise because he says it’s not fun and he gets no enjoyment from it. His weight is fine. At 6 feet, 2 inches, he weighs 186 pounds and his cholesterol and lipid profiles are all normal (LDL is well under 100). As a type 1 diabetic, is he setting himself up for a heart attack in mid-life if this lack of exercising keeps up?
When he “grows up,” is it possible that he will become more conscientious with his care? He is a bright boy and attends an Ivy League school. I hope he is simply going through a “rebellious” phase and he’ll get better with his care. He was VERY GOOD about everything during the first year of diagnosis. Then, he got sloppier and sloppier.
Answer:
He could be in a prolonged honeymoon with such good A1c despite such sloppiness with food. He could be extra wise about how he covers his food and whatever activities he has. We have seen many patients who say that they do not follow meal plans, but actually do since they just are more consistent than others. Your endocrinologist could check something called C-Peptide levels and, if these are higher values, this would suggest a prolonged honeymoon.
There are people who do not like to exercise and for them this is too much of a chore even though daily vigorous exercise is helpful for future prevention of cardiovascular problems as well as helping to manage diabetes. There is not much that a parent – or health care professional – can do when a patient does not want to change their health care behaviors except to make sure that current knowledge is available and to keep talking about possible beneficial changes since one does not ever know when maturity “kicks in.” Try not to nag but continue to discuss in an open-ended fashion. Perhaps suggest he try our site’s Chat Rooms or the dLife blog pages.
SB
