How can insulin doses be adjusted for better control?

Question

Hello doctor,

My 24-year-old daughter was diagnosed with type 1 diabetes three months ago, completely out of nowhere, and our whole life has changed. She was perfectly healthy, then suddenly lost 30 pounds in six weeks, was drinking water constantly, and urinating almost every hour. By the time we got to the hospital, her blood sugar was 487, and she was in DKA with a pH of 7.1.

She is on insulin now — Lantus 18 units at night and Humalog with meals —, but her blood sugars are still all over the place. Yesterday, she was 52 in the morning and then 340 after lunch, even though she calculated her carbs correctly. The endocrinologist wants her to start using an insulin pump, but she is refusing because she does not want something attached to her body all the time.

She is also really worried about having babies in the future with type 1 diabetes and whether it’s safe. Her A1C at diagnosis was 13.8, and at her last check, it was 8.1 — better, but still not great. She had to quit her job as a teacher because she kept having low blood sugar and even passed out in front of her students once. Is type 1 diabetes going to get easier to manage, or will it always be this hard?

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

Your daughter’s story of rapid weight loss, excessive thirst, and DKA(diabetic ketoacidosis) is classic for new-onset type 1 diabetes. It means her pancreas suddenly stopped making insulin, so she’ll need insulin for life. The key goal now is to balance insulin, food, and activity, and that learning curve takes time.

Right now, her blood sugars are all over the place because:

Her body is still adjusting after DKA.
The “honeymoon phase,” a period of partial insulin production, can come and go.
Insulin doses often need frequent fine-tuning early on.
Meals, exercise, hormones, stress, and even sleep can all shift blood sugar levels dramatically.

This early phase is chaotic for almost everyone, but it truly stabilizes with time, usually within six to 12 months.

2. About her insulin regimen:

She is currently taking:

Lantus (basal insulin): 18 units at night.
Humalog (bolus insulin): with meals.

That is a solid starting plan. However, since her blood sugars range from 52 to 340 mg/dL, adjustments are still needed. The endocrinologist will probably:

Refine her carbohydrate ratios (how many grams of carbohydrates one unit of insulin covers).
Adjust correction factors (how much one unit of insulin lowers her blood sugar).
Possibly split Lantus into morning and night doses, or switch to another basal insulin (like Tresiba) if variability continues.

A continuous glucose monitor (CGM), such as Dexcom or Libre, can make a huge difference. It allows her to see glucose trends in real time and get alerts for lows before they happen.

3. Insulin Pump: Why it is worth considering:

Her reluctance is completely understandable. No one likes the idea of being attached to a device. But modern insulin pumps are small, discreet, and can be life-changing for many people.

The benefits are that pumps can adjust basal insulin minute-to-minute based on glucose trends (especially when linked to a CGM). Fewer highs and lows throughout the day. Easier mealtime management and more flexibility with food choices. Some systems even automatically suspend insulin when blood sugar is dropping or increase delivery when sugar rises, known as a hybrid closed-loop system.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.