High numbers and sensitivity to all foods

My son is 16 years old and diagnosed with type I diabetes two years ago. Every since he has been diagnosed he has low blood sugars or within the normal range despite the amount of food he eats. He was on 2 units of NPH, and no Humalog insulin.  An outpatient boost test was done to test him for type 2 diabetes, confirmed as type 1. This day, she requested that he be taken off insulin. He was off insulin for two days with two numbers in the 200s and the rest within the normal range. His doctor was concerned about the lows and the limited amount of insulin he required so she requested that he be admitted to the hospital. In the hospital, three days after taking the boost test, he was given another glucagon test. Prior to checking into the hospital he was at 75. After checking in his numbers grew between 293 to 494. When released from the hospital, his numbers were still in the high 200 to low 300s. His endocrinologist increased his NPH & Humalog to 5 units each. However, we can't get his numbers down. At home, I have him on a zero to low carb diet and his numbers are just high. Everything he eats runs up his numbers. He's going to the gym for about two hours doing cardio & weightlifting. He was doing fine prior to hospitalization and could eat as much sugar free to low suger <4 foods he wanted. He had no complications and led a normal life. What could be the problem? It's like his pancreas doesn't know what to do. Has anyone else experienced this type of problem?

[JDRF-Team-sgg]

Your son may be experienciing what is called the "honeymoon phase" of early diabetes whereby the pancreas occasionally still does produce some of its own insuln at times unexpectedly or sometimes DOESN'T. I am a type 1 diabetic diagnosed at age 12 along with an identical twin sister.  At age 21 in grad school, the same thing happened to my twin as to your son. She was active and her insulin requirements dropped to the same dose as what your son is taking. She, too, was taken off insulin and the same thing happened to her. It is thought that for several years after the onset of type 1 diabetes, the pancreas may still produce small amouhnts of insulin in some people. When extremely active and burning off the food eaten, this insulin may be enough at times. But unfortunately, the pancreas usually stops doing this and the injected insulin has to cover for the loss.

My twin and I are both still able to control our diabetes with fairly low doses of insulin, and I believe that I still produce some insulin on my own occasionally, so I must be no the watch for lows at all times and must keep my warning signals healthy in order to protect myself. Your sone may need to do this also. Here are some suggestions:

Test frequently, especially at the times when his insulin may be about to peak. There are newer insulins than NPH and Humalog available that don't have the strong peak actions or that peak at the same rate as food is normally digested, and after 30+ years on NPH and Humalog, I can attest to the fact that these newer insulins work much better to prevent both highs and lows since they work at the same rate as the foods eaten. I would encourage you to ask your son's endocrinologist about the 24-hour insulin that acts as a base dose and the newest quick-acting insulins, which act immediately upon injection and dissipate in 2-3 hours (when taken at the same time as meals, they can prevent glucose spikes and protect your son from damages).

Your son's body will probably settle down to a predictable routine in a few years,but the teen years are hard. Testing every 2-3 hours is the real key to good control, for once you know what the numbers are, you can adjust food or insulin accordingly, just like the nondiabetic person's body does automatically.

You are doing the right thing while his glucose levels are running high. The low-carb meals now are safest until the dosage is adjusted properly. His dose of 5 units of each insulin is still a very low dose of insulin, and it probably will take much more than this to achieve good control. The cardio and weightlifting are good for him, too. Keep your chin up -- he will be fine and things will settle down in time. Just treat each number, one at a time, and he will be fine.