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From Atlanta, Georgia, USA:

My teenage daughter was diagnosed with Type 1 diabetes about 4 months ago and was handling everything very well and testing her blood about 7 times a day and feeling in control with her diabetes. Now, however, she is on a terrible rollercoaster ride with her blood sugars and any adjustments made to her Regular and NPH insulins seem to be less than adequate. If this is the result of her honeymoon period ending, is there a better way of helping her control her blood glucose numbers. Perhaps the new lispro insulin by Lilly? She is so frustrated. Stress is becoming an issue.


Your daughter's story is quite a common one and I doubt if it is due to the honeymoon period coming to an end, if anything that makes for rather easier control. There are several steps to take, the first might be to see if there is a nurse educator in the diabetes team that is looking after her with whom she can be in telephone contact, if necessary several times a week to talk about blood sugars, insulin dose etc. Secondly I wonder how much grounding your family has had in managing diabetes, sometimes the diabetes team will have refresher courses or you might find it helps to read a book like Understanding Insulin Dependent Diabetes.

The problem may also be one of stress rather than of understanding. Sometimes the realisation of what diabetes may mean to your life and the apparent eternity of injections and blood sugars can seem overwhelming and there may also be social or academic issues at school that you don't know about. Again if there is an experienced medical social worker or clinical psychologist associated with your diabetic team you might think to enlist their help in unraveling the behaviour problem. One small contribution that you could make would be to reduce the number of blood sugars done. You have set a pretty demanding schedule for a teenager and I would wonder if this could not be reduced to three or four.

I have emphasized the possible educational and psychosocial aspects of your problem because I think they need to be explored before coming to grips with trying to achieve better control by changing the insulin or the frequency of dosage. Once this has been done however your daughter is certainly old enough to consider 'intensive insulin therapy' which would probably mean lispro before or just after every meal and additional long acting insulin in the morning or evening. She might also be a candidate for a pump which also usually affords excellent control even though its management is quite demanding, at least to begin with.


Original posting 15 Mar 97


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