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Question:

From Virginia, USA:

My daughter is 13 1/2 years old. She was diagnosed with Type 1 diabetes 1 year ago. We are having a very difficult keeping her counts within the healthy range, particularly during the day. She takes 2 shots a day, using H, R, and N. Usually, we give over 50 units of N for her daytime needs, but despite our best efforts, her counts are in the high 200s by mid-afternoon. She has a small lunch (a sandwich, an apple, a glass of water). She is very unhappy that she ends up needing an extra afternoon injection. What can we do to improve this situation, without giving a lunchtime shot? Also, we have not been able to figure out the exchange/N insulin ratio.

Answer:

I would recommend that you meet with your physician/diabetes team to consider options available for better diabetes control. Some teenagers achieve better control with Ultralente (a long-acting insulin) in combination with Humalog, but this does require at least 3 or more injections per day. If your daughter totally refuses to do a lunch time shot, then N/R/H may be your best option. A dietitian or nurse on the team will be able to work on carb/insulin ratios with you.

Diabetes management is difficult at any age, but especially for adolescents. Hopefully with good support your daughter will decide that feeling well as a result of good control is worth the hassle of taking extra shots. A teen support group or a diabetes camp experience might also be helpful so that she can share her diabetes issues with others who are walking the same path.

LW

Original posting 14 Apr 1999
Posted to Daily Care

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