Reducing Insulin Resistance For Children And Teens With Type 1 Who Develop Elements Of Type 2
Below are examples of how a child or teen with type 1 diabetes can start to develop elements of type 2 diabetes (insulin resistance) and then start to reduce insulin resistance:
- A girl develops type 1 diabetes at 4 years of age. She has a father and an uncle with type 2 diabetes. She manages her diabetes very well with an insulin pump until about 11 years of age when she enters puberty. From 11 to 12 years of age she gains 22 pounds and from 12 to 13 she gains 18 pounds. By 13 1/2, she is very overweight and she needs to take on average about 150 units of insulin a day (more than 1.5 units per kilo of body weight). Even at that high dose of insulin, her blood sugars are not well controlled and her A1c is 9.2%. Her blood pressure is 125/80 (what is considered borderline), her cholesterol is a little elevated (her LDL is 121 mg/dL) and she has irregular periods. She has multiple features of insulin resistance.
Her parents, her doctors and she are concerned that she is gaining so much weight and needing to take more and more insulin. Everyone is worried about her A1c level. She joins a lifestyle program to learn better nutritional habits and also joins a gym. She slowly starts to lose weight and her A1c and insulin requirements improve. It appears that her insulin resistance improved with her weight loss.
- A 12-year-old boy shows signs of diabetes. He has had the typical 3 to 4 week history of urinating frequently, drinking all the time and weight loss of about 15 pounds. The weight loss was perceived as good because he had been heavy since he was about 8 years of age. The skin around his neck is slightly dark and thick. His grandfather has type 2 diabetes, and his father and mother do too.
At diagnosis, the boy is found to have antibodies in his blood so he is diagnosed with type 1 diabetes. He starts to take insulin and within a year he gains 30 pounds. The next year he gains another 20 pounds and he needs to take between 120-130 units of insulin a day via multiple injections. His A1c is 8%. The darkening of his skin is getting worse and his blood pressure is high (135/85). His doctor feels he has insulin resistance, and tries to help him lose weight.
His parents enroll him in sports programs at the local park, he starts to play football at school, he sees the nutritionist and stops drinking juice at breakfast, cuts out all sweetened drinks (like sodas and sport drinks), switches whole milk for skim milk, and starts to understand portion control. He loses weight over a 6 month time period and his insulin dose goes below 100, and the dark skin of his neck starts to fade. He appears to have improved his insulin resistance.
- An 18-year-old girl who has had type 1 diabetes for five years starts to have irregular periods. She has gained 10-12 pounds a year since the beginning of puberty at age 12. She's having a harder time controlling her diabetes, taking up to 20 additional units most days just to try to correct high blood sugars. Her basal insulin is 60 units a day and she needs more and more insulin for her insulin to carbohydrate ratio. With up to 140-150 units of insulin a day, her A1c is 7.8 but she has to take a lot of insulin to achieve that A1c level.
After graduating high school she goes on a strict diet, trying to minimize carbohydrate intake. She becomes a camp counselor for the summer and gets a lot of physical activity. By August she has lost 35 pounds and her insulin resistance improves and she starts to get regular periods.
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