Why are JR’s insulin needs dropping? | October 29 Question of the Week Rationale – Bev

Teenager with Type 1 on Insulin Pump

For last Tuesday’s Question of the week, about 55% of respondents chose the correct answer. Although the majority of people chose the correct answer, we wanted to write a rationale to this particular question since it highlights an important issue that people with diabetes may be facing.

Before you read any spoilers, if you haven’t tried the question of the week from October 29, you can take your best guess here:

Question of the week on October 29:

JR is 15 and has had type 1 diabetes for the past 2 years. JR started insulin pump therapy a few months ago and noticed that their weight increased by over 5 pounds. JR is very worried about weight gain. JR’s mom called the diabetes educator to share her concerns and added that JRs daily insulin usage significantly decreased over the past few weeks. What is the most likely reason for this insulin usage decrease?

Answer Options:

  1. Insulin needs decrease with pump therapy
  2. The insulin pump is not delivering insulin effectively
  3. JR is under dosing insulin
  4. Insulin needs decrease during puberty

As shown above, the most common choice was option 3, the second most common answer was option 1, then option 4, and finally option 2.

Congratulations! Most of you chose the right answer. Let’s explore the options in a little more detail.

Option 3 (C) is the correct answer: JR is under dosing insulin. In the scenario, JR has gained weight. This is coupled with the fact the JR’s insulin usage has decreased. These two items of information are red flags that JR is purposely decreasing insulin usage to let blood sugars run above target to lose weight. Sometimes this is termed “diabulimia”. It is important to recognize and address this issue right away to prevent potential complications secondary to acute and chronic hyperglycemia.

Option 1 is incorrect. Although insulin needs do decrease when transitioning from Multiple Daily Injections to insulin pump therapy, they don’t decrease significantly after pump therapy is established as characterized in this scenario.

Option 2 is incorrect since this vignette gives two key pieces of information: “JR is worried about weight gain” and “JR’s mom called the diabetes educator to share her concerns.” Although option 2 may be considered, by re-reading the question you can identify option 3 as the better answer between the two because of the details in the vignette. A great test taking strategy is to use the process of elimination to get down to two options, then apply careful, critical reading techniques to find the best answer.

Option 4 is incorrect because insulin needs do not decrease during puberty. In fact, puberty causes significant insulin resistance, which leads to increased insulin needs.

Want to learn more about insulin pump therapy and dosing? Check out our Technology Toolkit:

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