From Atlanta, Georgia, USA:
My 15 year old son was diagnosed 4 years ago with Type 1. For the last 18 months his average has always been over 190 and as high as 280. He receives 3 shots a day of Humalog and Lente on a sliding scale depending on his readings. His doctor has switched his insulins, dosages, and my son sees him every 3 months. During this period he has grown 14 inches (he is 6'2") and gained 40-45 pounds. He is very athletic so the weight is all muscle. We can not seem to get his average under 180, much less 140 as it should be. The doctor keeps telling me this can be normal for someone growing so much, so fast.
While the doctor tries to find the right dosages, we watch his diet, and my son stays very active. He has been very healthy. He has a few low episodes a month, he has never had to be hospitalized for high sugars (we check his ketones). I worry about the long term effects this is going to have on him. I hear and read about all the complications and worry that while healthy now it'll catch up with him later. Is all this normal when teens go through a growth spurt and will he be affected by it even if he seems healthy now?
You didn't mention any HbA1c value your son has shown over these four years of diabetes. This matters in terms of future complications even though his insulin regimen is actually not the best we can assure him so far to prevent diabetes complications and, last but not least, to improve his quality of life.
I'd think of delaying supper NPH till bedtime and see if this make blood sugars better at fasting. His broad clinical picture and past diabetes history look fine and your doctor's belief is probably correct if you consider the effect of puberty towards metabolic control.
Look for patterns of blood sugar over this difficult time and try to stimulate your son to adjust insulin regimen to a more creative one taking into account home blood sugar measurements. This takes patience as many things young patients must face over the "thunderstorm" period of adolescence.
Additional comments from Dr. Quick:An insulin pump might be helpful; your son could discuss this option with his diabetes team.
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