October 22, 2007
Insulin Analogs, Weight and Weight Loss
Question from Pennsylvania, USA:
My 10-year-old son has had type 1 for two and a half years. Prior to onset, he weighed 105 pounds, dropping down to 79 pounds just before diagnosis. In the next year and a half, his weight went up to 89 pounds, in April 2007. Then, this past week, when we went to the doctor, he weighed only 85 pounds. Something was mentioned to me about his body not storing calories. He is always hungry and seems to be looking at the clock constantly to see if it is snack time. I do not limit the serving sizes of the food he eats, unless it has a high carbohydrate content. Should I give him more carbohydrates and cover them with more insulin? Or, is there a chance of another disease? I could have sworn the doctor said he was doing blood work to check for Wellingtons, but I am not sure on the name. I tried doing a net search and found nothing. What I am afraid of is since he is not retaining calories, his body is feeding off of any muscle that he has and there isn’t much; he is very thin. He is 4 feet, 10 inches, 85 pounds, with clothes on.
Another thing I have noticed is that the Humalog is not working within 15 minutes or even a hour. Sometimes it takes hours for it to work and on several occasions, the school nurse would give him more insulin to cover that level, plus his snack before lunch and he would bottom out in the 40s mg/dl [2.2 to 2.7 mmol/L] or even 30s mg/dl [1.7 to 2.1 mmol/L]. I have instructed her not to give any insulin at snack time unless his level is 400 mg/dl [22.2 mmol/L]. He eats lunch one and a half hours after snack and since it takes so long for his fast acting to “act,” I would rather take the lessor of the two evils and have him high instead of low. Could the thyroid gland be causing this?
Answer:
What you report is very strange and extremely unusual, so I would urge you to go back to your diabetes team and ask more questions and see what they are thinking about. Celiac disease sometimes does this as does hyperthyroidism and Addison’s disease. Pernicious anemia and variants should also be considered, as should general pathology (looking at blood count, sed rate, liver and other general chemistry functions, etc). I would be extremely thorough looking for other explanations if there is no omitted insulin, no food or eating disorders/problems and no increase in A1c levels.
SB
[Editor’s comment: Please review with your diabetes team the timing of insulin shots. Fast acting analogs, such as Humalog, are better given about 15 minutes before meals.
BH]
