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Question:

From Olympia, Washington, USA:

Three years ago, my son at age 10, was diagnosed with type 1. His carbohydrate to insulin ratio was established at 20 to 1. He was given Lantus and Humalog. Approximately one and a half years ago, we decided to split his Lantus into two doses for morning and night to control the higher numbers he was experiencing when he woke up each morning. Soon after, his ratio began to expand to 30 to 1, then 40, then 60, then 80, and now 100 carbs to one unit of insulin. He has remained at that ratio for over one year now.

His doctor cannot explain why. Tests show that he is now longer producing his own insulin. I've talked to a Lantus representative who is unaware of any correlation between split Lantus doses and the situation my son is experiencing. It is not an easy situation for my son, as he has to eat at least 50 carbs to take one-half unit of insulin. He is also very active, participating on a swim team and in a martial arts class. Has anyone else experienced this type of result with excellent control of numbers or above-normal physical activity? He often experiences lows because of this situation.

Answer:

This is very, very interesting. In other words, you are describing that your son is now remarkably SENSITIVE to insulin.

There are a couple of possibilities that come to my mind. I don't think the splitting of Lantus is germane. But, if you want to test your hypothesis, stop splitting the Lantus and see what happens. (I wouldn't do this.)

It is possible that your son is SO active in athletics that he has really fine-tuned his metabolism well. This would be the best-case scenario. It is possible that he is taking extra-insulin without being forthright with you. This, I think, would be the worst-case scenario. In between would be the concerns that he has "something else" going on that can affect insulin sensitivity. Poor intestinal digestion of food would be one. Often, there is a history of on-going or recurrent diarrhea. But, Celiac disease, which occurs in about 8% of patients with type 1 diabetes, can be more subtle. Thyroid disorders and insufficient adrenal gland cortisol production can also lead to enhanced insulin sensitivity. These hormone imbalances also occur with some frequency with type 1 diabetes (up to 20% for thyroid disorders). All these conditions are related to the process that caused the type 1 diabetes, an autoimmune disorder that affects normal glandular function (or intestinal function in celiac disease).

I would also want reassurance that your son is not on ANY other medications, supplements, health foods, additives, etc.

Please let us know what you and his diabetes team learn.

DS

DTQ-20050222201748
Original posting 20 Mar 2005
Posted to Insulin Analogs and Exercise and Sports

  
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Last Updated: Tuesday April 06, 2010 15:10:02
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