July 21, 2003
Puberty
Question from Newtown, Pennsylvania, USA:
My almost 13 year old daughter (5 feet, 2 inches tall, about 120 pounds), who has had type 1 diabetes for three years, is on an insulin pump, and I can hardly keep up with her increasing basal rates. For several hours during the day, her basal rate is up to 2.9 units/hour, and it seems that her basal rates have been steadily increasing since she started the pump six months ago. (Her basal rate was about 1.2 about six months ago.). Her daily total for basal insulin is about 54 units, which seems like such a large increase to me. She does not have her period yet, but is showing other signs of puberty. Can puberty increase insulin requirements to this extent?
Answer:
You did not indicate her overall glycemic control. For her weight of 120 pounds (54 kilograms), a basal dosage of 54 units does seem a bit much. Perhaps she is not carbohydrate counting most appropriately. Perhaps, she is “missing” some boluses.
There are a number of ways that this can be better elucidated, some of which could involve observation in a controlled, hospitalized setting. I do suggest that you speak with her diabetes team about these concerns.
SB
