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February 2, 2004

Other, Puberty

Question from Cambridge, Ontario, Canada:

I would like some assistance sorting out some small difficulties my daughter is experiencing prior to her upcoming endo appointment. My 11 year old daughter was diagnosed with Type 1 diabetes two years ago. She has been pumping for seven months which has caused her A1C to drop from 10 to 7.6. She has experienced a lot of physical changes in the last four months due to the onset of puberty, including a significant increase in height and weight and onset of menses. Our concern is the difficulty she is having with heavy frequent periods as well as difficulty sleeping. Her periods last 7-10 days and can occur as often as every two weeks. She is also having difficulty falling sleep and staying asleep. She awakens frequently between 2 to 3 a.m. and is slightly confused. She adamantly claims that she hasn't fallen asleep yet. I know for a fact that she has slept because she snores loudly enough to be heard across the house for the first two hours after she falls asleep. I have checked to see if she is low or high when she awakens and she is consistently around 9-10 mmol/L [162-180 mg/dl]. (She exhibits hypoglycemic unawareness at night so our blood sugar goal at night is 10 mmol/L). Her morning blood sugars range from 4 to 13 [72-234 mg/dl]. The last two weeks she has begun to have difficulty also falling asleep and complains of feeling "high" despite normal blood sugars. She has a long history of asthma which is now fairly well controlled. She had her tonsils and adenoids removed at one year of ago due to frequent infections and apnea. She is not overweight, does not exhibit any signs of depression, but does have fingernails which grow very rapidly. Can you shed any light of any of these symptoms? Should I inquire about thyroid issues, anemia or sleep studies? Or should we continue looking at blood sugar patterns?

Answer:

Menses twice a month may happen very frequently in the early puberty and they generally normalize over the years. A period lasting up to 7-10 days is likely as well in this early puberty phase.

Regarding her sleeping difficulties, the most important reason as far as diabetes is concerned might be the low blood sugar levels or trends — even only in the pre-hypoglycemic ranges such as 60-80 mg/dl [3.3-4.4 mmol/L], especially in pumpers — over the evening before going to bed and over nighttime. You say you check sugars overnight and her sugar levels seem to be consistently well over the low ranges, but this pattern may not hold true also in the post dinner phase. In fact you say she exhibits hypoglycemic unawareness at night, she frequently awakens at 2 to 3 a.m. and her fasting sugar levels may range from 4 to 13. If any pre or true hypoglycemic episode is absent over the day and night, then the influence of her diabetes towards sleeping difficulties may be denied and I’d ask your endo for further help.

MS