I have a 15 year old daughter that has had t1 since she was 11 yrs old. She started her period at the age of 13 and ever since then, just about every month her b/s is high right about the time she starts and it put her into DKA, i can usually catch it before it gets too bad and give her the extra insulin and alot of water, but there has been at least 10 times she has ended up in the hospital with DKA. The doctor first accused her of not taking her insulin, then not eating right…i watch what she eats and WATCH or GIVE her her insulin every morning and night. When I told him this he says " everything you say sounds good, but its not how life goes" and is basically calling me a liar. I have looked up everything on the internet trying to find other teens like my daughter. And wondering if this sort of thing happens to other teenage girls…really need help and desperate…i know what this is doing to my daughter/her health and just need some input also.
Most diabetics experience DKA only a few rare times in their life. (Me = once at diagnosis, 18 years ago). That’s a huge concern that your daughter is experiencing it with almost monthly regularity. Her insulin levels cannot be right.
Does she pump? Many women adjust their basal insulin levels for the higher pre-menstrual blood sugars. If she doesn’t pump, she’s certainly a candidate for immediate approval.
How often do you have her testing her blood sugar? From mid-cycle until her period, I would have her test 8-10 times a day (upon waking, before meals, 2 hours after meals, before sleep).
And are you testing for ketones? I would be testing her for ketones every morning if she’s prone to rapid onset of DKA. A bottle of ketostix will run you $10-15 at the pharmacy and last for at least a month at that rate. Pregnant women test their ketones daily at certain points in their pregnancy. It’s not unreasonable.
You might consider consulting with your diabetes educator, as well.
The last thing to consider might be her self-image. Several members here have experience and firsthand knowledge about a condition diabulemia. I understand that you say your daughter is taking her insulin, but it’s understandable that the doctors first want to rule that out.
Thank you for your response.
She does test her ketones, thats how i know to up her insulin right before her period. For instance, she knew this past month that her b/s was high, she could feel it the day she started, we checked her ketones right away, they were moderate, she took 40 units of novolog and it only dropped her b/s from 550 to 338…then of course she started vomiting, so i know by that time its too late to contol it and have to rush her to ER. this only happens right before or the day her period starts. And we usually up her insulin by 5 more units right before her period also.
As far as the pump goes, we are in the process of getting her one now.
That’s just awful. What are her blood sugar levels like up until that day or on that day? Is it a slow steady climb or does she spike that day?
Do you chart her cycle? There are free websites that can predict for you. I’ve used mymonthlycycles.com with success.
I have to increase my basal on my pump to 110% or sometimes even 120% about 2 days before my period starts. Then decrease it to around 90% to 80% the day of and day after I start. It’s an almost every month thing.
Talk with a doctor about this. Maybe a female endo or diabetes educator. Or even a high risk women’s specialist. They may be able to help with more control during this time.
What basal insulin she is on? I have few teen girls with this problem, we solved by it by increasing Lantus dose few days before their periods ( all my patients take lantus in the afternoon) and go back to usual dose last day of the period, checking for Bg & ketones all the time. They go for low salt food, it decrease this bloating feeling and sense of restlessness.The pump will be ideal for your daughter.Best wishes.
Holly,
So sorry to hear this. Ten times with DKA:( I’ve been through that once–more than enough for anyone.
Don’t you just want to scream when doctors lay blame on the patient when they don’t know what’s going on!
Wonder if it might be worth asking her doctor about changing her brand of insulin. I’ve heard of people becoming resistant to a particular brand or type. Might not be making a huge difference daily, but perhaps when she really needs more at the beginning of her cycle it’s just not as effective.
Are her periods normal? Wondering they’re really heavy or have clots.
Sohair,
Why do your patients take Lantus in the afternoon? I’ve heard morning or night, or morning & night, & I’d like to learn why afternoon is good. Thanks.
life style is different here Gerri,during holiday children sleep all day and wake up at sun set,any short holiday they will reverse their sleep time ( hot weather or not).So we compromised,Lantus afternoon all year round,and it works.Also for those who wanted to fast during the month of Ramadan,it worked very well,no hypo,no hyper.We fast from dawn to sunset for a month.
I leant to adapt according to different situations to get the best diabetes control.
Thanks for explaining. Interesting. You’re such an incredible doctor! I wondered how people handled fasting with diabetes. I’m Jewish & our fasting holiday (sunset to sunset) just passed. I wanted to fast, but was worried I’d get ill not eating for 24 hours.
Actually Ramadan came this year in the summer holiday,while all children sleep at dawn and wake up before sunset ( missing prayers,you know we pray 5 times a day,dawn,noon,afternoon.sunset.and evening,all on time),so many of the children wanted to fast ( what fast is that,they were asleep!!!) so I encuraged them,they felt happy as long as they do not endulge on delecious dishes we cook in Ramadan ( many did,we increased the boluses,some who did not fast,ate freely and 2 were admitted in DKA.
I wanted to sleep through my fast as a kid, too! Told my mother–wake me up as late as possible. That didn’t cut it with her. I was told–this is a day of atonement & contemplation, not sleep. The hardest part for me as a kid was not being able to drink anything, not even allowed to brush teeth in the morning. I’d get so thirsty from not eating.
Hard to resist holiday special dishes. Sorry about the two DKA children. That’s awful.
I remeber when fasting as a kid,I will go and drink water from the tap.no one forced me to fast.but I loved to join the family.waiting with our lantern for the Azan ( call for Maghreb prayer) to break our fast.Beautiful childhood memories…
I’m 17 years old and have been hospitalized a few times with DKA. During my time of the month, my BG’s ALWAYS go high and I always get moderate ketones. My doctors explained this to be because of the hormones, and say what i need to do is give insulin. No matter what my bloodsugar is, i keep giving insulin and drink a lot of water, and if i still have keytones and my blood sugar is dropping, I’m told to give more insulin and drink juice. It was worse when i was on the pump, and i would have to give shots, but i recently switched to the pen and it seems to help. i usually have to stay home from school 1-2 days a month because of keytones, but the insulin usually makes them go away. I hope this helps, I know what your daughter is going through. Best wishs with everything!! I will pray for her that she gets it under control soon
I don’t know if you’ve already spoken to my mom about this, but I’m currently on NPH 33units in the morning and 33 at night. I was on lantus, but it wasn’t working for me. We’ve noticed that I’ve been best of Levemir, but my doctor wont switch us back over. He blames the DKA on me not doing what I’m supose to do, and about the pump, we’re working on that. I did my research and decieded that the MedTronic would be the best one for me. Thatnk you for your advise. :]
Well I am no teenager but in my type 1 history I always without fail get ketones every month right before and the first couple days of my period. Does not matter what my BG is. I test for them every morning as my sites tend to go bad at night. I have solved some of this by having a middle of the night snack. The only thing I can think of that makes a difference is as progesterone rises the digestive track slows and there is a greater resistance to insulin. If you fast you will make ketone like any diabetic at some point and your calorie need is a bit higher when your digestion is not working well. Meaning you get less nutrient value. So combine that with the high resistance and being a Type 1 you have a ripe environment for DKA .
Your daughter can have damage to hormone regulation for diabetes and this may be affecting her progesterone levels making them higher then normal. It is very individual. The few days a month I do this midnight snack or middle of the night gives me some extra nutrition because I make way to much progesterone so I need more insulin and less hours between eating. I can not get rid of ketone with insulin and water as well as normal BG during this time I need to eat also. If I do not the process just gets worse.
I have no idea if this will you I hope so. I eat for these snacks some string cheese or an egg with about 15 grams of carbs. It was by accident I found this working for me. The docs don’t understand it and either do I but it keeps the ketones away so I do it.
Be well and be loved
Thank you… we will try this
Hey i’m 15 myself, and i did a similar thing as what you said your daughter is doing, i know i put my mum through hell, i did it for 2 years, i didnt inject i lied about my blood sugars and to be honest as a person you feel absolute crap you constantly feel ill, but it becomes such a routine that i know i found it so difficult to get back to normal, im still getting there. What me and my mom did is we became more of a team, i know what i went through it i felt with all the stuff going on at school, i hjad exams boyfriends, friend troubles, you get intoducted to parties drinking drugs which obviously are a much greater risk for diabetics, diabetes gets pushed to the back of the queue it somehow doesnt feel important. Me and my mom did several things
In the kitchen we sorted out my own cupboard where i kept everything to do with my diabetes, tht ment that it wasnt all over the house and it was in one place, My mom took control of filling in my blood sugars and insulin into a blood monitoring book so we could see what my blood sugars were doing
I set my self weekly targets, so if i did say a reali good week wehere all my sugars were below a certain point a got like a surprise etc.
Also with Meals when you constantly have high nlood sugars as a diabetic you dont feel very well and so food actually often makes your feel worse, so as the blood sugars got better so did my aprtite also i went food shopping with my mum so i got what i wanted therefore it makes you feel more independant.
Also during this time i was finding it very hard to accept it that this was it life long nothing can change it.
If your daughter ever needs to chat to someone who doesnt know all her diabetic past and just wants a good old moan about how crap it is then feel free to give her my email address - holly_3443@hotmail.com
I hope that helps
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