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December 16, 2007

Hyperglycemia and DKA, Puberty

Question from Bulgaria:

My 10-year-old son has been using an insulin pump for 17 months. Recently, we are frustrated that his basal rates, which he's been using for several months, sometimes cause low blood sugars and sometimes cause high blood sugars, even if the same food is eaten. So, we find that we have to test his blood sugar 10 times a day, play with temporary basal rates and give correction boluses. Before, this was happening at night mostly but, these days, during the daytime, too, especially in the morning. He is waking up with a blood sugar of 6.0 mmol/L [108 mg/dl], but during the night he runs between 6.0 mmol/L [108 mg/dl] and 9.0 mmol/L [162 mg/dl]. We usually give him at least one more unit than calculated and find that, in two hours, his blood sugar is 15 mmol/L [270 mg/dl] to 16 mmol/L [288 mg/dl] or, on occasion 18 mmol/L [324 mg/dl] to 20 mmol/L [360 mg/dl]. We are seeing similar fluctuations in the afternoon, too. Why are we seeing such fluctuations?


I think you should try to increase the early morning basal rates since, based on the scarce information you have provided, it seems to me that this period of the day is not covered enough by current basal insulin rates. Be sure to consult your son’s diabetes team about this.


[Editor’s comment: One other possible explanation for the fluctuations, which may require basal rate changes, is the onset of puberty. This is a time when his body is undergoing so many changes that his diabetes may be more difficult to manage.