Making Sense of Glucose During Puberty
Balancing both requires delicate hand.
Q. My 12-year-old daughter is going through some erratic glucose readings – very high and very low. She might go to bed with a reading of 86 and wake up at 300. She always likes to have a glass of milk before bedtime but is this a good thing to do? When she is high she is afraid of eating and that is not a good thing. She is on an insulin pump and going through the early stages of puberty. Is all of this making things worse?
A. Undoubtedly, puberty adds another layer of complexity to diabetes management. During puberty, growth hormones kick into high gear and begin the process of sexual maturity necessary to transform the body into that of an adult. The associated increase in adrenocortical and gonadal hormones usually cause an increase in insulin resistance and thus, a worsening of metabolic control. Typically, insulin requirements increase and frequently change during puberty. Basal pump rates often need ongoing tweaking during this precious time.
Despite higher doses of insulin, other counterregulatory hormones contribute to fluctuating glucose values, and may be at play with your daughter's situation. For adolescents in a state of hypoglycemia (defined as less than 70 mg/dL, and for kids, lows may be considered less than 100), the fight or flight hormone—epinephrine—reacts to low glucose values earlier and with more force. Epinephrine signals the liver to release its glucose reserves. If you add that to a state of insulin resistance, it's no wonder adolescent glucose levels go all over the place.
In terms of your daughter liking a glass of milk before bed, give her the freedom to enjoy it! Many factors can raise her glucose levels in the morning (see related article on Dawn vs. Somogyi effect).
Unlike a glucose monitor that gives you a point in time glucose reading, CGM gives a steady stream of glucose levels and may help predict future blood glucose trends, and alarms when the glucose is too low or too high. Over a 3-day period, some devices can store nearly 900 glucose readings. For your daughter, this could help explain the details and patterns of nighttime information. The CGM can help explain why she went to bed with an 86 and woke up with a 300.
3. What about a diabetes camp? It is helpful to have fun and interact with peers in the same boat. Diabetes is frustrating and scary. Many people voice understandable fears over going too high or too low because of how they feel in those extremes, or the horrible complications that can happen with uncontrolled diabetes. I have heard many approaches. Some people avoid going too low (because they feel terrible or had a negative experience) and become comfortable with high readings. Other folks stay too low because of the threat of dangerous highs. Camps are a way to connect with others and learn what is working in their lives and what might be useful to bring home.
Many factors can interfere with diabetes in an adolescent, the hormones of which have been referred to as "anti-insulin". Being pancreas deficient while blossoming into adulthood with other fun glands is a parental recipe for hard work. Your daughter is lucky to have your caring concern.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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