What to expect in the teen and adulthood years?

Right now, Liam takes so little insulin (TDD between 6 - 8 units). Just reading @docslotnick’s response on how much basal he uses per day got me wondering. How much TDD should we anticipate Liam using when he enters puberty, then adulthood? How many vials (units/mL) do you teens and adults go through each month?

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It is actually quite variable, but on average we go through a little more than one vial per month. We also use Lantus and go through a pen per month during baseball season (4 months). Eating low carb, (<80 carbs per day) we average 25-40 units per day. We don’t throw any insulin out except what gets lost in the pump changes.


Harold, my son has gone from 120 to 135 lbs over the last 8 months: Over the same period, his TDD has varied between 30 and 70. When he is sick, he hits 70. Right now, he is typically around 45-50.

I should add that we don’t eat a lot of carbs, not because of him, but because we cook most everything from scratch (there are exceptions…) and use huge amounts of veggies. So, compared to most, we eat lowish carbs. My son eats btw 100 and 125 carbs per day (although he will eat a lot more right carbs to refuel after a long sports practice). If he ate more carbs, he would use more insulin. For instance, he decided to have an eggbeater omelet this morning --> no carbs, no bolus.

[EDIT] Forgot the insulin part of your question. We use about 2-3 pens of basal insulin and the same amount in bolus per month. We never throw insulin away either.

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YDMV, I’d say. I was diagnosed well after I hit puberty, so I can’t tell you what to expect when your son hits puberty. I’m in my twenties now and my TDD is usually between 25 and 35 units of Novorapid/Novolog a day, 29 on average. My TDD hasn’t changed much over time. Since I started pumping (half a year after my diagnosis) it has been around 30 units. I don’t know what my TDD was when I was on MDI. Currently, my basaI/bolus ratio is 40% basal vs 60% bolus. For the record, I have always been on a regular Dutch high carb diet. My TDD could have been lower if I were on a low carb diet.

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@Boerenkool, very low insulin use! You must be really sporty. Do you have a lot of homologous insulin?

Did you still have hormone peaks when you were diagnosed? We are all wondering in this thread when hormone peaks stop occurring?

Based on my TDD you might expect that, but the contrary is true. Apart from an occasional bike ride to the supermarket or the university (no more than 15 minutes), I don’t exercise a lot. I guess it has something to do with my metabolism.
This is probably a gap in my vocabulary, but what do you mean by ‘homologous insulin’?

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Do you still make some of your own (=homologous) insulin?

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I don’t know. One big difference between the US and the Netherlands is the use of CGMs. CGMs are rarely used in the Netherlands since they aren’t covered by insurance. Some hospitals have a small budget that they use to loan CGMs to a very limited number of patients, like pregnant women, patients with hypo unawareness or patients who have trouble bringing their high A1c (e.g. >8.5%) down. I’ve never been a ‘problematic’ patient and as a result I’ve never had a CGM. Insurance covers about 4-5 test strips a day, so the ‘testing 4 times a day-regimen’ is still quite common here.

Good question, my endo hasn’t ordered a C peptide test in years. The last time he did, I still had some C peptide.

During teenage years, I think the food consumption and physical activity are so different from one teenager to another that it is pretty hard to generalize. Body size (height and weight) also come into play and can also be drastically different from person to person. Teenage hormones kick in and muddy the water.

Safe to say it would be more insulin than your young toddler takes.

My point of view is there is so much going on in a teenager’s life. Believe it or not - more than just diabetes.
ha ha ha

We are fortunate enough to have great insurance coverage so the cost of insulin and supplies is not a factor for us at all.

I am not concerned at all about how much insulin is taken. Not even a whisker. I simply don’t care.

My focus is on finding places to make adjustments whether it be basal for particular time of day, insulin:carb ration for time of day, insulin sensitivity factor for time of day - you get the gist. I want to make our changes such that whatever food she chooses to eat will result in the best BG reading while trying to allow as normal a teenage life as possible.

I do really enjoy reading about all the very significant dietary choices people make and how it impacts their BG but in my opinion those are a better fit for adults.

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Re: hormone peaks, keep in mind that if your child is female (I think most of yours are not though), they will then be dealing with menstrual cycle hormones, which are generally underrated in their impact on blood sugars and it can be extremely dramatic (like what works just fine for one part of the cycle is completely off for another part). So for girls, that’s a particularly important thing to be aware of and watch out for, and tracking cycles once they start is likely a good idea.

I suspect that while CGMs are used more in the US than the Netherlands, online forums suggest they are way more common here in the US than they actually are (people here and on other forums are not at all a representative sample in many ways). The majority of people with diabetes I encounter in daily life do not have them.

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I think you are right. I read somewhere (cannot authenticate source) that they were about 1M CGMs in the wild today.

I am guessing that a lot of them are in the US. But that is still way short of all PWDs that are insulin dependent in the US.

I also notice, anecdotally, a lot of kids w diabetes who have a pump but no CGM, by choice.

Not all.

And it becomes quite obvious.