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From Botswana:

I have a 16 year old son with type 1 diabetes. He also has Down's Syndrome. He is currently on a two injection per day regime (Actrapid and Monotard). But I know that most teenagers are managing their diabetes on a four injection per day regime using the pen. Do you have any experience of Down's Syndrome people using an insulin pen? Has it been successful and what are the drawbacks experienced? To what extent are Down's Syndrome people able to achieve some degree of independence from their caregivers if using this regime?

I appreciate that this is a very personal issue, and that is why I am very cautious to change over to the other regime. I would like to know how other teenagers with Down's Syndrome manage their Diabetes, and what insulin regime they are using.


I understand your dilemma, but have little to offer because I don't know your son well enough to determine his level of functioning. Some young people with Down's are quite capable of handling this type of regimen.

I think you should discuss all treatment options with your diabetes team, including your son, and work out what will best meet his needs and allow some independence. You may also want to include his counsellor(s) in this team meeting.


Additional comments from Dr. Deeb:

This is a difficult question. Children with Down Syndrome function at very different levels.

Independence with diabetes requires the ability to plan, think "what if," and respond. Multiple injections require the ability to monitor the glucose, plan the meal (carbs) and determine the activity. From there the insulin dose is selected.


Additional comments from Dr. Kenneth Robertson:

As you are well aware, Down's individuals are very variable in their degree of independence and understanding. This is a critical factor in deciding what is the most appropriate insulin regimen. There is no reason to change to four injections just for the sake of it and this would not necessarily increase his independence -- indeed it could hamper him. What matters is his general control (HbA1c) together with an assessment (and his opinion) of what would be best. Without knowing any more, I would be inclined to see how he manages on his own with a two injection regimen before considering anything else. Four injection systems work best when they are being used flexibly and this requires a very clear understanding of how insulin, food and exercise will affect blood sugar results.


Original posting 21 Jan 1999
Posted to Blood Tests and Insulin Injections


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