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Question:

From London, England:

My 14 year-old daughter was diagnosed 18 months ago with Type 1. Initially her control was good. However recently, with the onset of puberty which was delayed, her levels have been very high. She is currently on Mixtard [70/30 N/R] 27 units in the A.M. and 24 units in the P.M. Blood sugar levels are running at before breakfast 12 mm/l [216 mg/dl] and before tea 15-17 mm/l [270-306 mg/dl]. We have been told not to increase her insulin and eat a larger snack before bed. There has been no noticeable change on this regimen.

What should we do next? Our diabetic centre is not helpful!

Answer:

I suppose the easy answer is to change where you get your daughter's diabetes care. However, before doing that, you should explain your concerns again and get them to explain to you their management decisions. There are many factors to take into account including your daughter's weight, her HbA1c and activity level. Generally, insulin doses rise during puberty but just increasing the twice daily doses doesn't always work. It is common to change to a system of three doses a day with a mix in the morning, soluble [Regular] at tea and isophane (NPH) at bedtime or even to a basal bolus system of three injections of soluble before meals and isophane at bedtime. Once again, individual needs and preferences have to be taken into account. If you don't get satisfaction, then you should seek a second opinion.

KJR

Original posting 11 Jun 1998
Posted to Puberty

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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