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Question:

From Pennsylvania, USA:

My son was diagnosed with Type 1 diabetes 2 1/2 years ago. He is now 14 years old. He presently takes 40 units of pork NPH and 17 Regular insulin daily. He is very careful with his diet and takes blood tests from 4 to 10 times a day. He eats at least 500 carbohydrates a day, of which are a combination of fat (25%), carbohydrates (55% - includes fruit, starch, vegetables), and protein (20%). He cannot keep his weight on. If he walks for 25 minutes his blood sugar will go to 30. He must eat almost every 2 hours just to keep his blood sugar up and maintain his weight. Are there any metabolic problems associated with diabetes that could cause excessive weight loss from mild exercise (walking)?

Answer:

I am a little confused by the information you are giving. You say "He eats at least 500 carbohydrates a day, of which are a combination of fat (25%), carbohydrates (55% - includes fruit, starch, vegetables, and protein (20%)."

This sounds like a lot of grams of carbohydrate. If you mean that he eats 500 grams of carbohydrate a day (2000 calories as carbohydrate) and that the carbohydrates make up 55% of the total calories a day, he must be eating close to 4000 calories a day which should more than enough for a 14 year old boy to maintain normal weight.

You also say that he takes 40 units of pork NPH and 17 Regular insulin a day, but do not mention if this is in one shot a day or divided between 2 or more shots. If he is only on one shot a day, he probably needs to have his insulin divided into at least 2 shots a day. If he is only on 1 shot a day, he may have too much insulin working at some times during the day predisposing to low blood sugars, but not enough insulin working during other parts of the day so that many of the calories he eats are being lost in the urine when the blood sugar is high and are not available for weight gain.

Other possibilities to consider that could cause poor weight gain in a teenager with diabetes are

  • An overactive thyroid condition and
  • Celiac disease (intolerance to wheat).

If you are not working with a pediatric endocrinologist and dietitian experienced in the care of teenagers with diabetes, I strongly suggest that you try to consult with such a team. Of course, in a teenager, another possibility to consider is that he may not be taking his insulin regularly. An evaluation by a social worker or psychologist might be helpful.

TGL

Original posting 9 Mar 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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