I recently solicited questions and got a taker (whoo!). katdiego asked: "Hi Julia, My daughter is almost 11, dx'd at age 6, wears a pump. I'm curious about puberty. At what age did you start noticing a monthly trend? What can I expect? I had heard that girls start showing an increase in insulin needs monthly for quite some time before they actually start to menstrate. And what about teenage rebellion? Does your daughter still take care of herself? Any advice on keeping you child engaged and conscientious about their diabetes care? Has she experienced burnout? I apologize if you have talked about these things previously. "

She also gave me some lovely compliments, so thanks, kat.

Puberty. It's a roller coaster and having diabetes only makes it more, uh, fun. Olivia started menstruating regularly shortly after her 11th birthday, although I noticed hormonal stuff going on for at least a year and a half prior to that. Every girl is different, of course, and luckily, Olivia is like me in that regard - she is like clockwork. In fact, we're now on the same schedule. My husband is just thrilled.

Her insulin needs have gone thru the roof. She goes thru about 150 - 180 unites every 2 days. Her basal rate is right around 50, over the course of the day. Her endocrinologist tells me this is pretty normal for girls her age (she's 13.5) and will taper off once she's out of her teens.

As for rebellion, I haven't really experienced that yet. I do have problems with her eating and not telling me or not bolusing and she tends to overindulge when I do have treats in the house, which is something I'm going to discuss in my next post. She's your typical teen. She rolls her eyes at me a lot. She heaves big, put-upon sighs in my general direction. I embarrass her regularly (which is actually rather amusing for me - I take my enjoyment where I can these days). But rebellion, no. We actually have a pretty good relationship and I make a concerted effort to keep things that way.

What keeps Olivia motivated and interested in her diabetes care, honestly, is going to Clara Barton camp every summer. She loves camp. She comes back from camp every year excited about new things she's learned from her friends, little tricks for treating highs or lows, novel ways of carrying her pump around and with at least a couple of new friends that she keeps in contact with over the winter months. It's been fantastic for her and given her a ton of confidence, in life as well as with her diabetes care. I'd crawl thru broken glass to make sure she gets to camp every year. It's really been that good. I get all emotional over it. I can't put into words what it does to my heart to see her grow into herself, into her own person. It's amazing. I can't praise it enough.

Now. Burnout. Yes, she gets burned out, but I think it's more that she's burned out by me asking her if she bolused, if she checked her blood sugars, if I can have her pump and meter to go over than the actual care. I know she gets annoyed and bummed and sometimes stressed out about it, but I don't think she's burned out all the time. There have been times when she's asked me to do more of it, but with the pump, there's not much more I can do. Some weeks, she wants me to do her site changes, and I'm fine with that. Most of the time, she seems fine with doing it herself. I think it's probably something I need to have a conversation with her about and then I can address it here, if need be, further. She's fairly self-contained and really only expresses feeling burned out when she's really frustrated over something - and sometimes she's just frustrated in general and it has nothing to do with diabetes.

I hope I've answered your questions fully, kat. If you, or anyone else, has any more, feel free to leave a comment and I'll get to them as quickly as I can.