My daughter is having a lot of highs

O.K. Everyone - I could really use some help (although I know I should be talking with her doctor too, and I plan to do that this week!)  My daughter was diagnosed two years ago with Type 1.  She is 11, in the full throes of puberty (despite her young age), has had her period for about 6 months, etc. 

At her last doctor's visit, we discussed her blood/glucose counts being all over the place (a typcial day is waking up at 279, being 206 at lunch, settling into a "normal range" for a few hours and spiking back up to high 200's low 300's for dinner and bed time.)  We've adjusted her ratios to 1:10 and 1:20 for meals and increased her Lantus at bedtime to 26 units.  She is now even giving her own shots (only about 2 weeks now, since she wanted to have a snack at 3:00 when coming home from school, but no one was home to give it to her and I was concerned this was spiking he rnumbers.)  The good news, she is able to have a snack now, I had stopped that due to the high numbers at dinner.  I feel she really is taking a shot, becasue I have seen her do it.  Despite all this, her numbers are still all over the place and I have seen no change in her dinner numbers from before she was taking a shot to cover the snack food (an apple, bag of popcorn.)  

Do you think this is just a pubery thing and we need to get through it?  Do you think she is not eating enough?  She eats lunch at school at 10:45 andis not hungry, so she only has cheese and crackers and a juice, and is then starving at 3:00 - do you think this is her body's way of saying hey, feed me?


If she goes to bed at a normal number, then wakes up high that would suggest her Lantus needs more increasing.  How long after meals is she spiking?  If she's a normal number before a meal, and 2-4 hours later is high and staying there, it would suggest her ratios need adjusting again.  But it sounds like her lunch number is ok.  It could all be related to puberty of course, but if it's happening many days in a row it's a pattern that needs addressing.

Puberty was THE WORST for me. I think I was high continuously from 6th through 9th grade. :P

I finally saw another endo who was like, "Why didn't your past doctor just raise your basal doses more?!"

I think we're often afraid to raise our insulin doses b/c it can lead to lows, weight gain, whatever. But, she's growing and starting to have adult hormones. It sounds like she's mostly running high, so lows aren't a big concern. I would definitely talk w/ the endo about raising the basals (and I:C ratios if she's esp high after meals) a bit every 3 days or so until the numbers are better.

Also, for a week before my period, I run high, and I run low for 2-3 days once I get it. She may find she needs to change her basals once a month now.

I also think that this age is when we're very self conscious about things and starting to hate our parents.  I didn't take care of myself like I should have, but I felt secretly guilty about it. When I finally got my numbers back down w/ that new endo, I was much more motivated and engaged in my care b/c I learned it WAS possible to have better control. Hopefully she'll be better than I was though!

I just reread the last part of your question. When I was in school and had an early lunch, I was always starving after school. It would be great if her endo could get her numbers such that she could have a light meal when she gets home, esp now that she can inject. Also, sometimes highs make me feel not hungry, but sometimes they make me feel more hungry.

Thank you so much for all of your comments - I am typing the correspndance to Katie's doctor now, and wil use your input - the part about you feeling guilty really strikes a nerve for me - she is very typically 11, pre-teen, etc. - a great kid, BUT also moody, worried about what others will think of her, etc.  She definitely understands needing to take care of herself, but is "rebelling" a bit against it too.  Typical but not easy!


Thank you again!

As much as "rebelling" is a natural part of being a teenager, it can be dangerous for us T1Ds in the long run.  Trust me on this one; I've been through it.  I started acting like your daughter at about that age too.  I wouldn't "share" my disease with anyone, but I also wouldn't necessarily accept the responsibility of taking care of myself either.  Long story short, my numbers would have been high most of the time, but I didn't even know it because I would rarely check (sorry, I can't remember if I was still doing urine tests at that time or if I had a glucometer by then...  those were the days!).  My bad attitude lasted a long, long time, probably something like 12 years!  I never went so high as to need to be hospitalized, but I did feel like garbage most of the time.  Then one of the common complications hit, even after I decided to buckle down some:  diabetic retinopathy.  It was not fun.  After the laser surgery did not work because the retinopathy was too far advanced, I ended up having four invasive eye surgeries, two in each eye.  The surgeries themselves were difficult for me, but the worst part was not knowing if I would have sight or be blind in the end.  Thankfully, the surgeries were a success and I have vision.  Not 20/20, but enough to be able to fully function, drive, read, etc.  The one thing I had to give up, that I used to love, were some sports that I played, such as baseball, volleyball, badminton and golf.

Conclusion:  the adolescent years are hard on anyone, but add in Type 1 diabetes and OH BOY!  Good luck to both your daughter and you!