Puberty, Thou Art A Heartless Beast!

To continue from my last post:

With that being Angelina’s first “real” illness since diagnosis, and with me suspecting that her honeymoon was drawing to a close I wasn’t sure how long after the illness was over I should expect before her basal insulin needs would go back to “normal”.  I polled one of my facebook diabetes groups and most people said about 10 days to 2 weeks before things went back to normal.  Well, the two week mark came and went and I was still programming Angelina for a 150% temp basal every day.  My suspicion is that the illness and the added strain on what was left of her functioning beta cells pretty much killed them all.  Her insulin needs have yet to go back down and over this past weekend I finally programmed in all new basal rates so I can stop doing a temp basal everyday.  It seems these increased insulin needs are here to stay.  In the past 3 weeks she went from an average of 15 units of insulin total over 24 hours (this includes basal insulin and bolus insulin for corrections and food coverage) to now her average being around 22 units over 24 hours and we’ve seen a couple of days where her total insulin for the day is closer to 30 units.  Her total basal rates alone increased from around 5 units to 8 1/2 units per 24 hours and this isn’t even with me addressing the nighttime highs we’ve been seeing.

She also is currently being insulin resistant at night time – which means she is running higher numbers and they aren’t responding well to the previous amount of correction insulin.  She is relatively insulin sensitive and her night time insulin sensitivity factor (ISF) was 175 since the start of the pump in July.  The ISF is the number of “points” that 1 unit of insulin is expected to drop her blood sugar.  For instance, if her blood sugar target is 150 and her current blood sugar was 325, then she would need 1 unit of insulin to get her down to 150.  This, of course, is not an exact science and depends on a lot of factors.  The expected rate of decrease really only works if diabetes existed in a vacuum. And, well, it just doesn’t!  But, with the recent insulin resistance I was seeing that 1 unit of insulin only bringing her blood sugar down 20-30 points over 2 hours or so.  Which, if you understand math at all, is a BIG difference!  And also means that when I would check and correct her blood sugar in the middle of the night I would expect it to come down to a lower level, but she was waking up not too much lower than she had been.

With her being on a pump one of the biggest signs that something is wrong with the pump or the infusion set and tubing is high numbers that don’t respond to correction insulin.  In this case you are supposed to either chance the infusion set and/or give correction insulin through a shot to rule out a pump problem.  If the person responds well to correction insulin by shot, then chances are there is something wrong with the pump/infusion set.   If even a shot doesn’t bring the blood sugars down, then the options are either the insulin is bad or not working properly, or the person is being insulin resistant.   In Angelina’s case, her blood sugar levels were more normal during the day and it was only at night that she was not responding well to the insulin that was coming from her pump, which helped to rule out a pump or insulin problem.

Nighttime insulin resistance is not uncommon, especially for kids.  Some common causes of insulin resistance, especially at night, are: growth hormones and puberty hormones (which are also growth hormones), or stress hormones (such as from an illness) and really just hormones in general.  I say especially at night because night time, during sleep, are when these hormones are most active.  Ever heard that you grow while you’re sleeping?  It’s true.  Hormones act as anti-insulin agents in the body and can temporarily cause insulin resistance.  In the DOC I have heard the phrase “My child is going through puberty.  It seems the insulin is like water because I just keep giving more and more and nothing happens!”

Puberty is a typically difficult time for any child (and parent) but this is doubly so for kids with Type 1 Diabetes.  The excess hormones cause the insulin to be less effective, resulting in higher insulin needs, sometimes with less than stellar blood sugar results.  Pair that with kids who are moody or trying to become more independent of their parents and don’t monitor themselves as closely as their parents did.  Being hungry and wanting to eat all the time because they’re growing.  Choosing less healthy convenience foods on the go.  And it’s a recipe for quite a lot of extra insulin needed.  It’s not uncommon for kids going through puberty to need much more insulin than an adult with type 1 diabetes.

So, how does a parent handle this?  By not sleeping.  I’m serious. Sort of.  Since Angelina’s insulin needs never came back down after her cold I have been doing more night time monitoring.  This wouldn’t be such an issue, and is pretty common for any d-parent, except that when I sleep there is no waking me.  Occasionally my 2 am alarm might wake me up, but most of the time if I am out- I’m out till morning.  Which means that I have been spending more time up late at night, often not going to bed until after 2am when I check her to make sure her blood sugar isn’t too high.  And then, I get up at 7 or so to get her off to school.  Thankfully, I’m a non-employed type person so depending on what’s going on that day I get to take a nap for a little bit while she’s at school.  It’s still not the same as getting a solid 8 hours of sleep at night though.

 

To be continued…

 

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