August 12, 2007
Daily Care, Other
Question from Colonie, New York, USA:
My 14-year-old daughter attended a diabetes camp for girls in Massachusetts for 11 days this summer. Her A1c prior to camp was 8.4%. Since she got home, she has been experiencing many lows and she only had two reading over 130 mg/dl [7.2 mmol/L]. Most of her reading are between 70 mg/dl [3.9 mmol/L] and 120 mg/dl [6.7 mmol/L]. Her control seems very tight, but the camp did not lower her ratios, corrections or her basals. Each time she goes to the camp, she experiences the same thing, lower blood sugars for a period of time after the camp ends. I am not complaining. At the camp, her food intake was limited to three meals and a few snacks consisting of fruit and peanut butter. Also, she was more active at camp than at home. She may be more compliant than before she went to the camp. I am trying to figure out why it is happening.
Here are my questions: Do you think her body needed a shock to her system (eating different foods with lower fat content and eating less often) and now her body is reacting to the insulin differently? Or, is it possible she is entering the values in her pump, counting her carbohydrates more accurately, and her pump is working more efficiently? Also, she was becoming more insulin resistant with a BMI in the obese range. Could the change in her activity and diet made the difference? The CDE is wondering why it is happening.
Answer:
If she is overweight then she is, by definition, more insulin resistant. At camp, with lots more activity and limited grazing, as well as better portion control because counselors are watching, likely she will have improved glucose control. This effect may last for days or weeks afterwards but then may dissipate as she goes back to less meticulous food and activity. This is all well known and not surprising. So, the key question that I might ask her is: why does she continue to overeat, be less active and have poor overall control? If she does not like this, then what might SHE change to improve things? There is no “food shock” taking place, just better meal planning with more activity. If she continues this, then she should lose weight and improve glucose control.
SB
