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Question:

From Argentina:

I've a 13 years old sister that is diabetic. My family and I are "fighting" daily to keep her strong and healthy. Therefore, I'd like to ask you the following questions:

  1. Which kind of insulin do you suggest for a 13 year old girl that is insulin-dependent for 6 years? She has two daily doses. The first one (before having breakfast) is of 37 units; the other one (before having dinner) is 14 units (insuline NPH porcina, Betasin).

  2. Her daily controls of her sugar levels have had an average from 120 to 160. Nowadays the control results are over 200. Do you think that this increase should have occurred due to her age? Do you believe that entering into the teenage stage could be the reason for this increase that we mention? We are very concern about this; are these increases usual at her age? Should she return to her previous averages?

  3. What are the possibilities to find a cure for diabetes in the future?

Answer:

Regarding your specific questions, here are my answers:

  1. Nowadays I, as most of endocrinologists, generally always suggest to almost every young type 1 diabetic patient the idea of intensified insulin treatment even though it's metabolic control that lastly matters. In your sister's case, the "two shots" insulin scheme, so frequent until some years ago among pediatric endocrinologists before the DCCT results, can hardly control the postmeal increases in blood sugar, leaving her at the risk of late premeal hypoglycemia.

  2. Check the values of glycosylated hemoglobin for a better assessment of her metabolic control. You are right that her pubertal age (13 years) can partly justify her blood sugars. Of course she should be aiming for the best metabolic control over all stages of her life and this can be obtained more easily if she switch to the multiple intensified insulin regimen. Don't be worried about short-term fluctuations of blood sugars because it's long term metabolic control that matters for all long term diabetic complications.

  3. This can be achieved but it will take some years more.

MS

Original posting 22 Nov 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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