The body’s insulin requirements are highest during puberty.
Puberty is the period of sexual development marking the transition from childhood to adulthood. It usually occurs around age 11 for girls and 12 for boys. Puberty’s physical, psychological and social changes have an impact on diabetes management.
Impact of hormones on diabetes management
The hormonal changes at puberty affect blood glucose control, often making it more difficult. Insulin’s effectiveness declines by about 30% to 50% because growth hormones and sexual hormones create insulin resistance. In non-diabetic children, the pancreas compensates for this resistance by secreting more insulin.
For the majority of adolescents with diabetes, their doses of injected insulin must constantly be adjusted to maintain proper blood glucose (sugar) control. When puberty is over, their insulin needs normally revert to what they were before.
The effect of these hormones is often strongest toward the end of the night. Thus, first thing in the morning, blood sugar can be abnormally high.
In some women with diabetes, blood glucose (sugar) levels fluctuate during the menstrual cycle, an effect also caused by hormones. Many women notice a rise in their blood glucose (sugar) levels a few days before they menstruate and a drop during the first days of their period, which can make them susceptible to hypoglycemia.
Social and behavioural changes
Adolescence is also synonymous with behavioural and social changes. These include a desire for independence, peer pressure on their food habits and physical activity, heightened concern about body image, and even about their diabetes. This can have an impact on how carefully they stick to their treatment protocol, and on their glycemic control.
From a diet perspective, adolescents usually have larger appetites because they are growing and need more calories. Eating out with friends can also influence their food choices.
Their daily meal plan should be adjusted with the help of a dietitian, along with an adjustment to their insulin dosages.
For a smooth transition
Obviously, you should arrange a meeting with the child’s health care team at puberty. The young person should be involved in any treatment adjustments and actively participate in meetings with health care professionals.
Young diabetics may become independent but parental support and attention is critical during this transition period.
Research and text: Diabetes Québec Team of Health Care Professionals
Scientific review: Caroline Boucher, Nurse Practicioner, CHU Sainte-Justine Diabetes Clinic
Geoffroy, L. and Gonthier, M., (2012) Être adolescent et… diabétique. Dans Le diabète chez l’enfant et l’adolescent, 2nd edition. Montréal: Éditions du CHU Ste-Justine, pp.451-465.
Tfayli Hala and Arslanian Silva. (2007). The challenge of adolescence: hormonal changes and sensitivity to insulin [Online]. Founded at http://www.idf.org/diabetesvoice/articles/the-challenge-of-adolescence-hormonal-changes-and-sensitivity-to-insulin (Web page consulted on August 5, 2014.)