Diabetes and puberty

Blood sugar roller coaster in puberty - but why?

Puberty typically happens between 9 and 17 years old, boys usually a little later than girls.

When puberty starts, estrogen (in girls) and testosterone (in boys) start releasing in varying concentrations (pulsatile). These hormones cause a decrease in insulin sensitivity. And due to the different levels, insulin sensitivity fluctuates, which explains the wild swings and stubborn blood sugars.

Most girls feel this as soon as their period starts. It usually looks like this: In the first half of the cycle, insulin requirements are generally lower, and in the second half of the cycle more insulin is needed. About five days before menstruation, insulin requirements increase again due to the increase in estrogen and progesterone.

Another hormone is also important: the growth hormone. It's responsible, as the name implies, for the growth that happens in adolescent life. It is released early in the morning and thus leads to increased blood sugar levels in the morning. This is also called the dawn phenomenon, which can be a problem not only in puberty but also for many adults. These hormones can increase insulin requirements by 1.5 times – this is entirely normal and happens with everyone!

It is normal, important, and necessary to adjust insulin settings during these crazy years. Most of the time, twice as much insulin (or even more) is needed for breakfast than usual. Also, your growing teen might suddenly have a much bigger appetite during puberty and eat huge portions! As a diabetes educator in practice, I am often amazed by how much these growing people can eat, and how much insulin is needed! But that's alright, their body wants to grow and that's where the calories are needed.

Brain process - curse and blessing at the same time

It’s not only the hormones and their fluctuations affecting blood sugar levels in puberty! The brain maturation process is happening too.

Teenagers experience massive mood swings within minutes with emotional swings to match. Of course, that makes it even more challenging to respond calmly to fluctuating or inexplicably high sugar levels or annoying questions from worried parents. And don’t forget ringing pump, meters, and CGM alerts.

Young people may want and should become independent. For children or adolescents with diabetes, this might mean push back when asked for blood sugar or sensor values ​​again and again.

What they want is to manage diabetes alone, hang out with their friends, and chill out. And it’s a delicate balance for parents and caregivers to help them do it safely while taking on more responsibilities.

Of course, it is essential to nail the essentials – no skipped insulin or medications, not ignoring too many alarms, and remembering to change pump sites regularly. And try not to be frustrated by high values! Do the best you can, together. Correct and carry on.

Exchange and peer support

For adolescents with diabetes, there is also a lot to be said about resources from your clinics: there are often training programs, teenage camps, and, as uncool as it sounds, "self-help groups." Any of these may help your teen to be more self-confident and independent in dealing with diabetes.

Also, regular appointments with your endocrinologist and diabetes educator to review and adjust the insulin dosage or discuss specific situations, are indispensable. Teamwork is the order of the day!

Things get exciting again when your teen officially becomes an adult! Switching from pediatric diabetes care to adult diabetes care can be scary for them, especially if they’ve grown up with that pediatric provider. Ask your current provider for help with the transition.

Better together

It is essential for children and their parents to be involved in therapy together as early as possible. It helps enormously if the growing teen can make safe insulin adjustments, count and calculate carbs, or change their own sensor or infusion site. And it allows parents to let go and trust.