Shortly after her son Alex turned 13, north Texas mom Tracie noticed a change in his blood sugar control. His numbers were running slightly high … almost all the time.
“Because he was diagnosed at age 5, knowing when to test and how to cover carbs [with insulin] were both pretty old-hat by the time Alex became a teen. When he started coming up with these high readings all the time, I just couldn’t figure it out,” she remembers.
To get to the bottom of this trend, Tracie questioned her son about things like “sneaking” extra food when out with friends and being careless with entering information into his pump. It only made things worse.
“First came the highs, and then — on my part — came the nagging. Was he eating too much with his friends without bolusing for it or being careless and not testing after eating? Was he depressed? Something was definitely up, but the more I got on him about it, the more he withdrew.”
At her son’s next endocrinologist appointment, Tracie finally got an explanation. Turns out, it wasn’t too much soda or lack of testing that was the main contributor to her son’s high numbers. It was his hormones.
Not Just Those Hormones
Beyond the behavioral issues that often crop up at this age, it can be a surprise to parents and caregivers to find out just how much fluctuating hormone levels during puberty affect blood sugar control.
The biggest culprit? According to Melinda Penn, M.D., assistant professor of pediatric endocrinology at Virginia Commonwealth University in Richmond, Va., “Growth hormone seems to be the hormone that has the greatest impact on blood sugar control and insulin sensitivity during puberty.”
Human growth hormone, which surges during adolescent growth spurts, can decrease how efficiently the body uses insulin, mainly because it makes cells more resistant to insulin’s action. In adolescents without diabetes, the body simply makes more insulin to overcome this resistance. In adolescents with type 1 diabetes, however, the typical result is a significant increase in insulin requirements, Penn explains. By some estimates, adolescents with diabetes may require as much as 30 to 50 percent more insulin than adults do in order to keep their numbers within range.
In the case of Tracie’s son, sure enough, Alex had grown three inches since his last check-up. Her doctor then advised her how to adjust his insulin doses for the duration of the growth spurt.
It’s not just growth hormone that’s on the rise during puberty. What about those surging sex hormones, including testosterone and estrogen? “The exact effects of sex hormones on diabetes aren’t fully understood,” says Penn. From what is known, however, it appears that changing sex hormone levels affect girls more than boys. “Estrogen generally improves insulin action, but this doesn’t seem to be the case in girls with type 1 diabetes,” she adds. Parents of girls may also want to keep an eye out for delayed puberty, increased weight gain, and irregular menses, for which girls with type 1 diabetes may be at higher risk.
With all this going on beneath the surface, plus the normal behavioral changes experienced during puberty — including teen rebellion and increasing desire for both privacy and independence — adolescence is often the recipe for a rocky few years for kids with type 1.
Tracie’s son Alex is now 21 (and 6’1”). He remembers well what it was like to go through puberty with diabetes.
“My skin was bad, my voice was cracking, I felt awkward every second of every day. I had no idea why my numbers were high. I didn’t even think about my diabetes much — I just didn’t want to trip over my feet walking to class! But there was my mom accusing me of disconnecting my pump,” he recalls. “I know she was just worried. But my reaction to all this was, ‘well, if you think I’m being all sneaky, maybe I will be!’”
Jenna Eisenberg, M.S., L.M.F.T., a Denver therapist who specializes in treating people with type 1 diabetes, recommends that when trying to keep tweens and teens on track with good diabetes care habits, parents need to keep both these hormonal and behavioral changes in mind.
“Being a teenager is hard. Being a teenager with diabetes is even harder,” says Eisenberg, adding that issues such as diabetes burnout, rebellion against normal care routines, “diabulimia” and depression are of significant concern among kids in this age group.
How do hormones factor into behavior? “Changing hormone levels can affect blood sugar control, but they can also create mood swings in kids. This can add to everything else a teen might already be experiencing and make a bad situation completely overwhelming,” she notes.
Getting Through the Rough Patch
To best help kids cope, says Eisenberg, “acknowledge and validate your child’s feelings, and try to come up with ways to promote self-reliance.” In light of growth spurts, changing insulin needs, and a tween or teen’s increasing need to spend social time with friends and feel more independent, parents can also respond positively by sitting down with their child to create a new, more adolescent-friendly diabetes management plan. This might include different foods your child would like to eat, changes in insulin dosing, and more frequent blood sugar checks that your child will be responsible for carrying out. Your care team can help with putting together a flexible plan.
Eisenberg also recommends building in some kind of incentive for kids to reward them for taking the steps needed to keep their blood sugars within range.
“To get kids through this time, I’ve found that positive reinforcement — something like screen time as a reward for consistently checking blood sugar and following through with other care tasks — really works well,” she reports.
What advice does Alex have for parents of teens with type 1? “Try to keep your sense of humor and try to imagine life in your kid’s shoes. Maybe you can remember what it was like to be 13, but you probably don’t know what it’s like to be 13 and have a disease that none of your friends have. You probably don’t know what it’s like to have to stop and check your blood sugar all the time when no one else has to.”
“Think about these things and then have a little patience when we have a high or low, or we skipped a check. It happens to the best of us.”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.