From Terre Haute, Indiana, USA:
Our 15 year old daughter was diagnosed with Type 1 diabetes two years ago. Since that time she has been hospitalized at least 10 times with uncontrolled high blood sugars. She has been seen by outstanding diabetologists, endocrinologists, and pediatric specialists all over the country. No one has been able to solve her problems. We have been told by various doctors she is the most difficult case they have ever encountered. We have been told she is insulin resistant, but only part of the time.
Sometimes her blood sugars are excellent. However, for some unknown reason periodically it will take massive amounts of insulin to reduce her blood sugars. Often no amount of insulin will be effective and she will have to be hospitalized and placed on an intravenous insulin drip which will usually reduce her blood sugars.
For your information she is 5'6" tall and weighs 125 pounds. When healthy, she is extremely athletic and very active. Up until about four months ago she was taking multiple daily injections 4 to 8 per day. She is now on an insulin pump, which we were told was her last hope for achieving fairly normal blood sugars. It hasn't helped. She has used H, R, NPH, and U insulin. With the pump she is on H. When she is feeling good, and nonresistant, she needs about 40 units per day. When she becomes resistant she takes over 200 units per day and still has blood glucoses in range of 500+.
She was hospitalized again two weeks ago. Shortly before hospitalization (when feeling good) she had sensitivity factor of 60 (i.e., one unit of H reduced her blood glucose 60 units). The factor then changed to 43, and now it is 19. Unfortunately, once the insulin finally starting working her blood sugars drop rapidly, often over 100 mg/dl per hour. She will often have lows in the 30-40 range.
I apologize for the length of this e-mail. However, we are at a loss as to what to do. Our daughter desperately needs help, and we don't know what to do or where to take her. We realize there isn't a quick fix. Please suggest where we might take her to get results. Incidentally, it was recently thought some of her problems were related to irregular menstrual cycles. She was placed on birth control pills but this too has not helped. Thanks for any suggestions.
It sounds like your daughter is having an extremely hard time. Very rarely there can be syndromes of insulin resistance with spontaneous remissions. This may be caused by antibodies that excessively bind the insulin then release it (insulin is not active when it is bound). Another rare cause of insulin resistance is caused by antibodies that bind to the insulin receptor. These antibodies can either interfere with the action of insulin on the receptor (essentially blocking the action of the insulin) or paradoxically stimulate the receptor (causing an insulin like effect).
Unfortunately, the most common cause of the situation you have mentioned is secretly omitting and giving extra insulin. Psychotherapy is indicated in this instance.
[Editor's comment: The scenario that you have described is most often found to be associated with the intermittent omission of insulin. In such cases, evaluation by a psychologist or psychiatrist who is familiar with teenaged diabetic girls can be lifesaving. WWQ]
Original posting 14 Nov 97
Last Updated: Tuesday April 06, 2010 15:08:53
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