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Spike in insulin needs in 13 year diabetic son
by Oldstuff, Jan 04, 2005 12:00AM
Background- Logan, Diagnosed at age 6, now 19. Well controlled for 8 years, not so well for the past 5 years. Suddenly reports having readings that fluctuate greatly, and taking an average amount of insulin (split shot, 70/30) and having to supplement at night with 20 to 30 units of regular insulin (in 10 units at a time) and still having high readings. I seem to remember some talk of this sort of thing happening to long term patients for some particular reason but do not remember what initiates it or what the implications of the situation are. Does this scenario ring a bell with anyone?
Doctor's Answer
by JDRF-Team-SS, Jan 04, 2005 12:00AM
Helllo Oldstuff,
First I want you to know that I am Not a medical professional, so my input/advice is solely based on my own knowledge from personal experience.
My son, almost 10yrs. old was diagnosed at the age of 3. My sister also has type 1 - was diagnosed at the age of 24. (8 yrs. ago)
My son is now on the pump. (started at the end of Aug. 2004) Before that he was on NPH and Humalog. I am sorry to sound ignorant, but, although I have heard of 70/30, I am unfamiliar with how it works. I am guessing that 70/30 insulin is in lieu of NPH, but the question is...does he need regular to cover food or does he only get the regular insulin at night as you mentioned?
What does his Endocrinologist say? The only thing that comes to mind for me is that he has done a lot of growing from 14 -19 yrs. of age, going through puberty, etc. If things have been up and down and the BG readings have fluctuated greatly (as you say) for the past 5 years, I am surprised his Doc has not made any significant changes to his insulin schedule and / or type of insulin. DO not get me wrong, I am not crticizing his Endocrinologist. (although it may sound like it) Possibly he made changes and they just have not helped??
I am sure his appetite is much bigger than when he was a kid or even a pre-teen. Also, I am sure you have also heard of other insulin types such as lantus and humalog. You see, as I mentioned my boy recently went on the pump. Well, my sister (who starts the pump this Friday!), is currently on lantus (she takes a shot at bedtime) and then humalog for a correction, as well as humalog to cover what she eats. (carbs) I am not suggesting you do this, but talk to your son's Endo about the possibilities because if for 5 years BGs have been up and down, something definitely NEEDS to be changed. (I know you already know this and that is why you are posting here.)
Personally, (and I am not promoting a particular company or anything) we (my son and I) have been VERY please with the pump and if given the chance to go back to shots, he would say, "No, Mom, what are you crazy?" LOL
As you know, Oldstuff, this disease is so unpredictable and I am sure Logan has done so much growing and I am guessing that although insulin has been increased as he grows, you are still having this great fluctuation in BGs and I can understand as mother of a child living w/diabetes that this concerns you.
Please talk to Logan's doctor and please feel free to ask any other questions. I am so sorry that I cannot shed light on this and give you a straight forward answer.
There are many volunteers here who are VERY knowledgeable when it comes to different insulin types, the human body and diabetes and I know that you will receive comments.
Please keep us informed.
Warm regards from another Mother:)
First I want you to know that I am Not a medical professional, so my input/advice is solely based on my own knowledge from personal experience.
My son, almost 10yrs. old was diagnosed at the age of 3. My sister also has type 1 - was diagnosed at the age of 24. (8 yrs. ago)
My son is now on the pump. (started at the end of Aug. 2004) Before that he was on NPH and Humalog. I am sorry to sound ignorant, but, although I have heard of 70/30, I am unfamiliar with how it works. I am guessing that 70/30 insulin is in lieu of NPH, but the question is...does he need regular to cover food or does he only get the regular insulin at night as you mentioned?
What does his Endocrinologist say? The only thing that comes to mind for me is that he has done a lot of growing from 14 -19 yrs. of age, going through puberty, etc. If things have been up and down and the BG readings have fluctuated greatly (as you say) for the past 5 years, I am surprised his Doc has not made any significant changes to his insulin schedule and / or type of insulin. DO not get me wrong, I am not crticizing his Endocrinologist. (although it may sound like it) Possibly he made changes and they just have not helped??
I am sure his appetite is much bigger than when he was a kid or even a pre-teen. Also, I am sure you have also heard of other insulin types such as lantus and humalog. You see, as I mentioned my boy recently went on the pump. Well, my sister (who starts the pump this Friday!), is currently on lantus (she takes a shot at bedtime) and then humalog for a correction, as well as humalog to cover what she eats. (carbs) I am not suggesting you do this, but talk to your son's Endo about the possibilities because if for 5 years BGs have been up and down, something definitely NEEDS to be changed. (I know you already know this and that is why you are posting here.)
Personally, (and I am not promoting a particular company or anything) we (my son and I) have been VERY please with the pump and if given the chance to go back to shots, he would say, "No, Mom, what are you crazy?" LOL
As you know, Oldstuff, this disease is so unpredictable and I am sure Logan has done so much growing and I am guessing that although insulin has been increased as he grows, you are still having this great fluctuation in BGs and I can understand as mother of a child living w/diabetes that this concerns you.
Please talk to Logan's doctor and please feel free to ask any other questions. I am so sorry that I cannot shed light on this and give you a straight forward answer.
There are many volunteers here who are VERY knowledgeable when it comes to different insulin types, the human body and diabetes and I know that you will receive comments.
Please keep us informed.
Warm regards from another Mother:)
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I'm writing to echo what SS wrote to you. Seems that many Type 1 need the greater flexibility that a separate Long-acting & short-acting insulin provides. This is exactly what your son is doing by taking extra shots.
Regular used to be our only choice in short-acting insulins, but now we have access to even quicker-acting insulins (Humalog & Novolog). Each one has a quicker onset, does its job, and "gets out" more quickly than Regular does, too.
Encourage your son to work wiht his endo and/or schedule a visit with a certified diabetes educator (CDE). CDEs specialize in helping us diabetics tweak our treatment plans to suit our lifestyles. This approach is far superior that trying to make each of us create a rigid, inflexible lifestyle just to suit a particular insulin routine.
While there's comfort in the familiar, SS shared a coupla of pretty typical examples of folks moving beyond their initial comfort zone to strive for better control. IMO, pumping has given me BETTER results for LESS work, once I learned the technology. Teens are usually more comfortable with technology than "old folks" like us ;-)
Good luck and let us know what your boy ... err, young MAN ... decides to do, okay?
See if he won't go back to the endo and go over what he is eating and drinking, and see if there isn't a new regimen he could adopt.
Logan would have produced some of his own insulin for some time after being diagnosed. This can go on for years. And it is probably why he was able to achieve good control with supplemental insulin.
At this stage, he must be totally dependent on injected insulin. Which makes controlling blood sugar levels a lot more difficult. And it calls for a regimen that gives Logan more control. Biphasic and Regular insulin simply doesn't do that. Blood sugar levels rise and fall in an unpredictable and very confusing fashion. And good control becomes unachievable.
First prize would be to put him on a pump. It is the most responsive and flexible system available. But if you can't do that, get him on a basal/bolus regimen. Lantus is often referred to as the "poor man's pump" because it provides peakless basal action. And injecting Humalog or Novolog before meals will enable Logan to accurately balance his food, exercise and insuilin requirements.
When he feels in control Logan will rise to the challenge. And he will do what has to be done to achieve good control.
Cheers,
Mark
I am not a doctor, either. I have a 12 year old son that was diagnosed with Type 1 at 2 years of age, and has been using a pump since October of 2003, and used Humalog and NPH by injection before that.
Your son's problem could be caused by many things, as the other posts point out.
One thing I didn't see mentioned, yet, is the possibility that your son might need to find some new injection sites, or possibly do a better job of rotating injection sites. It is well known that overused injection sites can eventually cause poor absorption of injected insulin, resulting in poor control of blood sugar levels. After many years of injections, some areas may we worn out. You should consider this and try injections in areas of the body that have not previously been used. Be sure to ROTATE injection sites, as well.