April 30, 2006
Daily Care, Hyperglycemia and DKA
Question from Sydney, Australia:
My 13 year old son has had diabetes for just over one year and has been on a pump for around eight months. He has had excellent control, with A1cs of 6.6. He is diligent about carbohydrate counting and blood testing. Over the past few weeks, his blood sugars have become quite erratic and he seems to be very insulin resistant at mid-morning and dinner time. I have checked his pump operation, meal bolusing, infusion site, etc. and can find no reason for these spikes. When given correction boluses, these do not seem to have any effect and we often have to give him around three times the normal correction bolus before he starts to come down.
His diabetic educator and endocrinologist don’t have an answer and say that it may be related to puberty growth. He is in the midst of a growth spurt, but can that really cause such extreme blood sugar spikes? We cannot raise his basal levels to counter these rises as they do not happen every day, but are finding that responding with correction boluses is not working very well either. What else can we do? What is the cause? Will the erratic sugars continue?
Answer:
I suspect that your diabetes team is correct and these are the usual, intermittent burst of growth hormone and/or other puberty related hormones. If the A1c is so excellent, then this indicates that the overall average glucose values are terrific and you are making reasonable corrections so that the high sugar spikes are not of such long duration. This all calms down on its own after several years of adolescence. Frequent monitoring will help you identify when these are occurring. What you need to do is work closely with your diabetes team on how you should respond, at what levels, with what extra boluses, etc. Looking for patterns is frustrating, but may be helpful with computer downloading programs. It is quite common to need a lot more insulin, for instance, to compensate for overnight growth hormone surges and, thus, for the relatively high insulin resistance at the breakfast meal and post-breakfast bursts compared to other times of the day. But, go back and work with your team to see exactly what response is required.
SB
