May 14, 2002
Daily Care, Puberty
Question from Waxahachie, Texas, USA:
My 10 year old son, who has had type�1 diabetes for two years and is on NPH with Humalog twice a day, always has needed insulin adjustments during the month depending on what his blood glucose is doing, but lately the adjustments are happening every one to three days. On a given total dose, his can be anywhere from 40 to 300 mg/dl [2.2-16.7 mmol/L] with no more variation in food and activity than previously. His diabetes nurses review his log reviewed monthly, and they confirm that we are making the appropriate insulin adjustments as needed and are not overreacting.
For six months, he has been on treatment with Isoniazid [INH] for inactive TB. This drug affected him predictably during the first few months of treatment but now, we don’t know what is going on. The only possible signs of puberty are that he has gained a significant amount of arm strength since the beginning of the school year.
The endocrinologist has not given us any answers as to why things are different, and more difficult, now. Any information you may have will be greatly appreciated.
Answer:
Something has obviously changed, and you dodescribe signs of puberty — perhaps. You should go back to your son’s endocrinologist and ask these specific questions again, perhaps with a long conference specially arranged for this purpose in advance to do some problem-solving. It’s unlikely to be an INH effect, but certainly is a remote possibility. If there has been a documented growth spurt then this would also be a consideration and could be seen with weight and height gains, of course.
SB
