From Mobile, Alabama, USA:
I found out from my teen son, who has had diabetes for about four years, that he's been lying to the doctor about his insulin intake. He says now that he takes 11 units of Humalog in the morning and 25 units of NPH in the morning as well, six units of Humalog at lunch, 11 units of Humalog at dinner, and 17 units of NPH at bedtime. He eats 60 to 75 grams of carbohydrates at breakfast, lunch and dinner, and a snack of 30 grams of carbohydrates between breakfast and lunch, and 15 grams of carbohydrates between lunch and dinner, along with 40 grams of carbohydrates at bedtime. He had an A1C of 6.3 last doctor's appointment.
Why did he tell me he was lying? Well, in about a week, we're going on a trip overseas, and the doctor switched him to Lantus and gave him a dosage based on his insulin intake, which was a bogus insulin intake. Now, his doctor went on vacation as well and we can't contact him. I was wondering, first, how to talk to my son about this. I don't want to come down hard on him because he is already not open with me. Also, I was wondering if you could prescribe a dose of Lantus and Humalog for the time between now and when we can contact his doctor.
There are big issues here that cannot be easily addressed through this forum. Sorry.
Not knowing your son or you and your levels of knowledge of diabetes, I cannot offer a dose of Lantus. But, if your son's physician is out of town, I would think that "someone" must be on call to cover for him and THAT person might have access to the chart to make a recommendation. In very, very general terms, some people advocate that the amount of Lantus, given once a day, typically before bed, would be about 80% of the total daily dose of NPH previously administered. So, if he were on 25 units of NPH in the morning and 17 units of NPH in the evening (total dose 42), then a calculated dose of Lantus is about 34 units. But of course, it REALLY hinges on the true doses of NPH that were successful. And, you have just indicated that you may not really be certain of what dose the boy was on.
As for his lying...that is also very difficult. There may be many reasons why the young man has been deceitful. Usually, the child is trying to "give the answer the doctor (or parent) wants to hear" fearing some type of penalty if the truth were really known.
You didn't really elucidate what the untruthfulness was all about, but you indicated that the A1c was 6.3%. I presume that was the physician's report and not your son's report. So, whatever he was doing seems to have been working as that value is quite good.
Unfortunately, the other side of the coin of your "just learning" that your son has not been totally honest in his diabetes management is that your son has not been supervised at home in this regard by a responsible adult either. So, how do you approach this? Openly and without being a heavy. Shoulder some of the responsibility that you must have, unwittingly or not, put some pressure on the boy to force him to make a choice between the truth and a lie and then explore why he felt he needed to lie. Also, shoulder your responsibility for not being able to double check him and help supervise his diabetes plan of insulin and meal planning. Explore ways to bond better.
Last Updated: Tuesday April 06, 2010 15:10:08
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