How long do spikes due to puberty last?

Parenting a D-Child Child
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My son is almost 10, and last we checked he didn’t have even the beginning signs of puberty yet. But the last few days he’s had a really, really stubborn high. He’s been HIGH on Dexcom and getting between double and triple his normal insulin dosages. He doesn’t seem to be sick, nervous, stressed, eating a lot, or any of the usual suspects. His average blood sugar for the past 3 days is 191 mg/DL.

We’ve changed his sites, his cartridges, his insulin, put on a “sick day basal profile” that adds 20%, then done manual injections we don’t log on the pump, overbolused for carbs, the whole 9-yards.

Finally this morning, we injected the normal dose of long-acting insulin we’d give if he was NOT on a pump, but kept his pump on. He has slowly, over several hours, come down to 132.

Over the past three days he’s basically been below 180 mg/DL for a total of 12 hours. We’ll douse him with insulin for hours, he’ll briefly touch down in the normal range after a bout 6 hours of stubborn highs, and then he’ll soar up again.

We’re pulling out our hair as this is clearly awful for him and it wreaks havoc on his average blood sugar.

Does this sound like puberty, or are the hormone-induced insulin resistance spikes more transient?

And if it’s NOT related to puberty or sickness, what else can cause this? He’s about as active as usual. Just had a soccer game yesterday in which he killed it, and that’s usually a fairly intense level of activity. Today he’s out and about as usual.

And do you guys have strategies for very quickly bringing down highs like this because he’s getting really, really frustrated with us constantly “bothering” him with corrections.

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Does Control IQ (I think that is what you guys use?) allow remote Boluses? I don’t have answers into why this may be happening (kind of early for those puberty highs i would think), but if you can remote Bolus that would at least take some of the stress off of him. So sorry you are going through this. You are doing all the right things and I’m sure he’s staying hydrated and testing for ketones regularly.

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Control IQ does allow boluses from the phone, but only from one phone and we don’t want him to have that option, so we haven’t enabled it on the one with him. But I agree, it may be worth setting up on my phone because this is getting out of hand.

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Yes, this sounds like hormones.

And yes, the issue in this case is that those growth hormones are causing insulin resistance (as opposed to other hormones that result in spikes because they trigger a release of liver glycogen).

A strong basal will be helpful. In this case, perhaps a “stealth” dose of Tresiba would be good, because then it would not interfere with your pump’s “expected” BG.
(I hate when you take a bolus because you know you are going to go high, and your pump thinks it’s smarter than you, so it cuts off your basal!)

Another thing that might help would be IM shots. They work faster. They are not really that scary. Just get 1/2 inch syringes or needles, and put it in his arm like a flu shot or Covid shot. It’s pretty simple and would work better knocking it down. And as an added benefit, would also be a “stealth” bolus.

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Wow! Looks like you are right! I thought I had another 2 or 3 years before starting to worry about this but it looks like it could be sooner than that, as Sampson seems to be experiencing! The best we will be able to do as parents (my plan anyway), is to hang on tight and prepare for the ride. :frowning: We have the knowledge…just execute what you know to do and ride it out. Remember, “this too, shall pass.” I find myself saying that a lot to stay sane. Lol

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When there’s a dramatic change it’s easy to get caught in looking for reasons and lose sight of the fundamentals.

My guitar was in perfect tune yesterday and it sounded great. Today it’s way off. What’s going on? Is it humidity? Temperature? Something else?

Doesn’t matter, just tune the guitar.

If my BG is too high, I need more insulin. If it’s going too high for no good reason like eating or illness, then I think about adjusting the basal, because the job of the basal is to hold the BG relatively level when nothing else is going on, and that’s easier than a constant stream of correction boluses.

Of course I have to be ready to back off on basal promptly when lows start happening.

With fluctuating hormones the problem is that the guitar is always going out of tune. It’s a nuisance, but just tune the guitar, that’s it.

Increase the basal bit by bit until the BG is good. Watch for lows that indicate it’s time to back off on that basal increase. And always have glucose tabs close by; that’s fundamental safety.

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I want to offer a slightly different opinion on this.

Yes, when our BG is too high we need more insulin. And we treat it that way and move on.

But the underlying reasons can be very helpful to identify.

For example, maybe a person with diabetes gets Covid but feels none of the typical Covid symptoms, so they don’t know they have it. But instead of coughing, they might notice a huge increase in their insulin requirements. So maybe that makes them think they should take their temperature. It’s higher, so then they get a Covid test. In this example, rather than only treating it, they treated it but also looked into the possible reasons.

I think diabetes gives us a great way of seeing things that non-D’s can’t see. I use my insulin requirements all of the time to spot things. Like am I eating more than normal? How am I feeling? Was this social event stressful to me?

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I never tune the diabetic guitar without first identifying a pattern! That is super important to me because many of the reasons that could cause shifts in BG may be temporary. So before i tweak anything, i personally always look for patterns first. If i see a high between a certain time for a week, two or three, then i tweak basal and/or ISF. One setting at a time so I can see the change and assign it to a particular variable changed with the result of the change.

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Yes, I noticed that going in to teach at the start of this semester was followed by a slow, steady rise of almost 40 points over the hour. That’s comparable to what it went up when I had a crown put on. I must really love my job! Anyway, after observing this a few times I started pushing a unit or so before class started even if I was at 100, since I could predict I’d need the cushion. Fascinating bit of indirect self-insight.

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But the underlying reasons can be very helpful to identify.

Totally agree. Identifying the cause helps with minimizing the highs – I may be quicker to resort to certain tools versus others if I understand what it’s likely to be. Samson ALWAYS goes high during soccer games, and now that I recognize that’s going to happen, we can preempt it somewhat with a short-acting bolus beforehand. But if this is going to be a spike that lasts three days, it makes more sense to use a long-acting injection to supplement.

But beyond that, it just generally helps with health. For instance, if it’s caused by frequent site failures, maybe we need to change where we put his sites, what types we use or if we do a pump break.
If it’s caused by puberty, we may need to test his growth hormones as he’s short.
If it’s none of those things and he’s just randomly become super insulin resistant, maybe there’s some underlying medical problem we need to assess.

True, in the end you treat the high and move one, and obsessing over it isn’t helpful. But recognizing patterns and being proactive definitely is.

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