My 13 year old daughter, who has has type 1 diabetes for five years and has not had a menstrual cycle yet, has had blood sugar control problems for about a year. She wears an insulin pump, and we have tried to keep up with basal rates related to the growth spurt and weight gain. Also, she is a gymnast and exercises about 10 hours a week. How much does puberty affect control? We are going crazy trying to keep it all in range.

Puberty is a very delicate phase of life when there is a progressive increase in the production of the most important growth and sexual maturation hormones which have profound effects against insulin. Things change when the child has to face the insulin deficiency of type 1 diabetes, and the type of insulin regimen and the quality of self-management matter in terms of ability of maintaining the same good metabolic control as before over these difficult years until adulthood, when finally, the metabolic scenario gets stabilized. This is not always an easy task and an insulin pump should theoretically offer a better solution. You and your daughter might want to try an intensified insulin regimen using the pump with the help of her diabetes team, and get involved with their counselor for the care of adolescents.

It is not exactly true to state that high blood sugars prior puberty have no deleterious effects. In fact, nowadays, we know that good, and conversely bad, metabolic control matters from the very beginning of the diabetes history although the hormones produced during puberty probably speed up the negative impact of bad metabolic control on complications of diabetes. Therefore, our advice is to try to always manage diabetes aiming at the best metabolic control no matter the age of the person who has it.

MS