From Downey, California, USA:
My 13 year old, a type 1 diabetic on pump therapy, has recently had skyrocketing blood sugars (300 mg/dl [16.7 mmol/L] to 450 mg/dl [25 mmol/L]) with mild to moderate ketones. They seem to occur during the period between ovulation and the onset of menses. She has gained weight recently and is now about 160 pounds at 5 feet, 8 inches, but she's a competitive athlete (track and volleyball). When she has these highs, it is extremely difficult to get her blood sugars down and I worry that all the extra insulin might even be contributing to her weight gain. At midnight last night, she tested at 240 mg/dl [13.3 mmol/L] and we corrected. At 2:00 a.m., she was 180 mg/dl [10.0 mmol/L] and we corrected again. At 6:00 a.m., she was back over 200 mg/dl [11.1 mmol/L] and never had anything to eat. In fact, today she fasted until her numbers went down under 130 mg/dl [7.2 mmol/L], which wasn't until 2:00 p.m., and we had tested every two hours! Could she be developing insulin resistance? Might a change from Humalog be advisable? The nurse at CHLA told me that this was not uncommon during the teen years, but I can't help but be nervous. Any information you can provide will be GREATLY appreciated. I'd like to have as much information I can to provide her doctor when I call Monday.
I wonder if she is keeping the catheter in place too long, i.e., more than two days. We have many people with such problems that go away when the catheter is replaced at a maximum of 48 hours. Also, some people think that NovoLog works better than Humalog, so this is worth discussing as well. If she is just insulin resistant during parts of her cycle, then she needs a lot more insulin than you are providing, based upon these very high blood sugar readings. Also, weight loss becomes extremely important if you are to break this cycle coupled with cutting down carbohydrates and total calories. You should go back and discuss this more specifically for individual recommendations for your daughter.
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