#54 TEEN SERIES part 2: Insulin Needs in Teens with Rachel Halverson, CDCES

Episode 54 features Rachel Halverson, CDCES. If you remember, Rachel is the trooper that joined me for ALL 10 weeks of the newly diagnosed series. Today, Rachel and I discuss a general overview of insulin needs in teenagers with Type 1 Diabetes. Rachel has been living with T1D for the past 25 years and has been a volunteer camp counselor at Camp Kudzu in Georgia for years working with teens of all ages. This episode describes what is going on physiologically in a teens body throughout puberty and how that may be reflected in the insulin needs and blood sugars. WARNING: This episode does cover what may be considered as more young adult and adult topics such as the menstrual cycle in case you have little ears listening and want to avoid an onslaught of potentially awkward questions on the way to school.

Find Rachel and her online coaching business, Give Me Some Sugar, on Instagram.
Check out the camp where Rachel volunteers at, Camp Kudzu, in Georgia.
PRODUCT FEATURE OF THE WEEK: Mirabalm, the all natural adhesive remover!
Summary of Studies on Teens with T1D click HERE! 

Transcript

Katie: 0:00

My name's Katie and you are listening to episode 54 of the sugar mamas podcast. And the second installment of our teen series today, Rachel Halverson is back to talk to us about insulin needs in teens, in general. Obviously every teen is different and your diabetes may vary, but this will provide a general overview of what's going on in their bodies and how that might be reflected in their insulin needs. If you remember, Rachel is the certified diabetes care and education specialist that joined me for all 10 weeks of the newly diagnosed series. Rachel has been a teen with diabetes herself, as well as a volunteer diabetes camp counselor. For years, she's been working with teens while at summer camp. For a very long time and she shares some of that experience with us towards the end of the episode, just an FYI. This episode, it does discuss what may be considered as more young adult and adult topics such as the menstrual cycle. So if you have younger ears listening and don't want to answer a million potentially awkward questions on your commute to school, here's your chance to hit pause. One more thing I want to mention before we jump in, is that at one point, Rachel mentioned. P C O S for the record that stands for polycystic ovary syndrome. All right. Let's get started. You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseboro. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks. Rachel, first of all, how are you?

Rachel: 2:13

I'm doing great. I'm excited to be here

Katie: 2:15

I know, I'm excited. You're back. Are you allowed to tell people what you're doing now? Rachel just got a new job.

Rachel: 2:21

Sure. Yeah, I'm super excited. It's a startup that is like an insurance benefit. So if you work for a certain company that opts into this benefit, it's for people with type two diabetes specifically, but. Cool is kind of to like overall goal is diabetes remission, or getting you to a point where we can take you off of insulin or some of those, the medications that put those people more at risk for like low blood sugars. So especially with type two diabetes, when you're more insulin resistant, which we will talk about so much today. Cranking in more insulin is not always the best solution. So we're, we work with them. They get like a little health coach and then a nurse and a physician and a dietician, a whole care team. And we work with them on making some changes in their lives so that they can kind of hopefully start to come off of one or more of those. But I really enjoy it.

Katie: 3:15

Very interesting. I know I need to learn more about the type two side of things. I have some people in my life that I love dearly that do have type two. And I feel like right now I'm

Rachel: 3:23

you

Katie: 3:24

on type one for good reason, but

Rachel: 3:26

well, we honestly, yeah, we, I would not. Be where I am in terms of my control of my type one. If I didn't know about type two, like when I started learning more about them and what they are doing, it, it started to make sense for my own diabetes because we really that's. Something we don't talk about at all is, is all the stuff that we experience. As a person with type one, it's not just insulin deficiency. There's so many other hormones as we'll talk about today that go out of whack. When your, when your beta cells aren't cooperating anymore. You know, it's, it's glucagon, it's GLP one. It's, it's all these different things that start to malfunction. And, and for some reason we, we get the short end of the education stick where. They're just like here's some insulin that'll it'll fix you. Yeah. So that's, definitely worth kind of learning about and talking to those, people that live with it because you'll definitely notice some similarities in your own life.

Katie: 4:19

You know, I'm going to ask you to come back on and talk about it at some point in time. Now that you've said all that.

Rachel: 4:23

I'm ready.

Katie: 4:24

All right. So teens, this series came about because. I've had a handful of parents of T one D teens come to me and say, I'd love to learn more about managing type one in my teen. And I, I feel like, I don't know, cause I'm not those parents, but I feel like probably at least 50% of those concerns have to do with just teens in general and not So much type one. Throwing type one on top of the teenage years, I'm sure just complicates things, even so much more cause just when your kid is, you know, wanting more independence and wanting to be on their own a little bit more, you're still trying to cling onto that control of them manage their type one. So I just feel like it's gotta be such a hard time, but. Today, we're not talking about emotions so much. We're talking about insulin. So as far as insulin needs go and teens, boys, and girls, what do you tend to see?

Rachel: 5:18

So you will most definitely see them increase pretty significantly This is for literally every teen going through puberty. They their insulin resistance. So the insulin is not working as well as it used to, which means we're going to have to put in more to make up for that. So even, even children without diabetes experience that increased insulin resistance when you have type one, again, because of all these things that are going on, it's significantly worse for them. So it's. Greater need. And especially when you have been paying attention to it, it's going to, it's going to be pretty it's an impressive increase. Like for example, when I was I don't remember a lot of like what my insulin to carb ratios were like. I'm sure those were insane, but when I was. Going through puberty. I was taking like 60 units of long-acting insulin and like currently as an adult. And I think when I was a younger child, like when I was five, I was taking like maybe 20, 20 units of insulin. So it went up pretty, quite a bit.

Katie: 6:23

Yeah. that's three times more. Do you remember around what age that started for you?

Rachel: 6:28

I don't know. From what I understand. It does actually start a little bit before puberty. So you may see a little bit of that kind of as the hormones start doing some things. Even though it's technically, we're not quite there yet. Some, some parents do notice that there, they may see a little bit of an insulin increase and as totally normal. So maybe around. 10, 10 years old yeah, I really don't remember. I just remember. The only reason I remember is because I gave myself 60 units of short acting insulin. Instead of Lantus. And I'll always remember it because I got to eat a lot of cake, but I thought about it later. And I was like, why was I taking 60 units of anything? And then the fact that, that, like, I really don't think I even ate that much. So I think that kind of speaks for. How much short acting insulin I needed to eat, just, you know, good amount of dessert. But it was, yeah. And it just, it makes it really difficult to, because behaviourally, you know, your team is going to want it, you know, their metabolism is increasing significantly and they're gonna want to eat a lot of cake. So you're, you're really gonna see a lot of a lot of changes in regards to. The insulin dosing that you're going to have to make. so that's, that's really the biggest, the biggest change you'll notice is just increased insulin resistance, which means we're gonna need more insulin.

Katie: 7:51

Can you speak about just, you know, puberty is this kind of blanket term, but what is going on in their bodies that is causing this insulin. resistance? What, what hormones are causing that?

Rachel: 8:03

the biggest factor is growth hormone. And that of course is if we produce it like our whole lives. So you'll often see even prior to puberty or after puberty, sometimes you'll see a little, like, I always get a little spike around midnight and that's just kind of normally where growth hormone is, is at play, but it does cause insulin resistance. So when we're going through puberty, You'll have an increased amount of growth hormone in the body, and that affects the metabolism and the absorption of insulin. For whatever reason, I don't know if the body had a reason for it when it decided that that was going to be a thing, but it definitely makes life a little bit more difficult. so yeah, the growth hormone is a big player in that I believe desktops. Has a little bit of a insulin metabolizing sort of effect as well. But it's yeah, for, from my understanding growth hormone is kind of the big player there, especially. During the time that you are growing so much. the women, you know, women tend to produce a little bit more, we're all producing these things, but you know, your puberty is the time that you are producing those sex hormones are what we call them. So estrogen testosterone are the big players. And then the growth hormone so all of those things sort of play into it. And we honestly don't know like a lot about kind of how they, how they affect specifically. Like, I, I did a lot of reading on estrogen because I was interested in like how birth control. You know, women and their insulin needs and all that good stuff. And we just, unfortunately haven't done a lot in regards to what those different things do. Sometimes we find estrogen makes people a bit more insulin sensitive. Sometimes testosterone makes people more insulin sensitive, but I think main player here to worry about would be that, that growth hormone. It's very it is very prominent during puberty and it that's generally what is causing some of our group.

Katie: 10:01

Right. And so is it, you know, cause right now I feel like Sarah goes through growth spurts. So there'll be like a day or two here and there where I'm like, whoa, she is running so high and we've done, you know, nothing different than I can really think of. And, and I feel like it's probably because she's growing. Cause you know, now we have. A few more doctor's appointments than we used to. So I can see the change in her height and her weight. And it's like, oh wow. She really did have a little gross right there. But throughout the teenage years, is it kind of more like the growth hormones turn on and then they just, are you going to see those spurts, like I'm seeing now? Or is it kind of like they turn on and then day they just stay on for several years.

Rachel: 10:43

I think it's fairly persistent. But there definitely is a little, you know, we go through stages. They're the Tanner stages in, in purity. from what we know, girls tend to stay pretty steady throughout puberty in regards to their insulin resistance. Whereas boys tend to for whatever reason around 15 and 16 is going to be. The moment of most, most growth hormone and most insulin resistance. So that's kind of just a general, again, you definitely depends on you personally. Somebody may have a boy that is just like a growth hormone party the whole time. And so yeah, you may, you may notice a little depths, but for the most part, the growth hormone is pretty it's less, less of a spurt growth spurt and more of just a giant couple of years of a growth spurt.

Katie: 11:32

right? Yeah. A three-year long growth spurt.

Rachel: 11:35

Yes, it's really traumatic.

Katie: 11:37

I know, I wonder if they've done any studies in teens that don't have type one, it's studying their blood sugar. I wonder if they just run a little higher naturally because they're more insulin resistant as well.

Rachel: 11:48

That's a great question. I'm sure they do. But yeah, it's always, it's hard to say. Considering we, again, it's something we don't really take. Think about the type ones again, need a little bit we're naturally there must be some sort of insulin resistance that we have naturally because we tend to take more, our total daily dose is more than somebody without diabetes. So it might be kind of hard to compare. But yeah, that would be really interesting to see if they are needing more insulin or if their blood sugars are more elevated. I'm sure it, yeah, I assume the body does it because it wants us to get fatter, but

Katie: 12:26

I wonder if that has anything to do with it just with, cause you are putting on weight at that time. And some of that weight is fat and you know, just well, I mean, I'm just thinking about eating a fatty diet can make you more insulin resistant too. So I wonder if like just

Rachel: 12:38

Right.

Katie: 12:39

in fat in the body. But while everything's adjusting as part of the reason too, I'm throwing out a lot of ideas over

Rachel: 12:45

no, that, that is yeah. And that's, that's something that, you know, we typically girls are more insulin resistant and a lot of that has to do with the fact that they tend to have more body fat. So, yeah, body fat, it plays a big, a big part of kind of the level of insulin resistance that you have. And that being said, it is, is super important. You know, girls with type one are very much at risk for gaining a lot more weight during puberty. Which totally sucks because there are. You know, stressed out about all of these things that are happening and the way society is and, and that sort of thing. So, yeah. As a, as a parent of a girl with type one, it can be really, yeah. You have to be very Kind of getting into that body neutrality and kind of just sort of watching those changes, but that definitely adds to it. If you, if you have more body fat on you it's kind of a vicious cycle. You're more insulin resistant with more fat on you and then you need more insulin. So that tends to add a little bit more than if we continue on that cycle. So it is, it's really frustrating and that's Hopefully it doesn't happen. You know, it's not too significant during puberty, but it can be really frustrating for, for young young people when that when they're experiencing that.

Katie: 14:01

Yeah, Can you, can you speak to your experience as a teen with type one? Do you remember being really frustrated with diabetes at the time? Or was it just kind of like, oh, this is what I do.

Rachel: 14:10

Yeah, I think because I grew up without CGMs, I didn't have as much of a Awareness kind of, of what was going on. I think my yeah, I think maybe my parents were more aware of those changes than I was, cause I just would finger poke and then react to it. I didn't have that idea of, you know, seeing where the graphs were going and what my averages were, which is really interesting. So I, I was pretty carefree it's not something I remember. I honestly remember experiencing in regards to diabetes at all. I think that's probably just because I wasn't looking at the CGM and I think that's important too, is kind of I'm, I'm curious as. The CGMs kind of do the effect they have on, on our team's kind of mental health and that sort of thing, because I know as an adult, I obsess over it and I can imagine if I was going through a time where everything was going up, then there wasn't a lot I could do about it. It would be really frustrating. Yeah.

Katie: 15:07

absolutely. I it's. So I wish we could go back and somehow magically see. Data from

Rachel: 15:14

Yeah.

Katie: 15:14

that didn't have CGMs, but we're obviously still using insulin and, things like that. Because I, I mean, I bet I would venture to say that their numbers probably, maybe weren't quite as good as somebody who has a CGM and is like diligently trying to keep numbers in range. Which a little bit gives me hope because I mean, obviously this is just a hypothetical situation, but, you know, it's just like, I feel like. We're probably doing a pretty good job. You know what I mean?

Rachel: 15:41

Yes, absolutely. I think about that all the time. So whenever my newly diagnosed type ones are in a panic, I'm like, look, I lived like 15 years without a CGM and I'm still alive. it definitely helps a lot because you can see. The aftermath and it really hammers home pre bolusing. Like, I don't think I ever pre bolus because I just didn't see what that meant. So yeah, I think people definitely have a lot tighter control now because they can sort of see everything. But that being said, it is, it is comforting to know that there were people that were just sort of peeing on those tablets and putting, putting them into the little. Pickups and they're still, they're still doing fine. You know, I met, I was on a plane a couple of years ago and there was a sit next to like a 90 year old man. I was like, first of all, why sir? What are you, where are you going? And then but he had type one diabetes. So and he was, he was telling me he's like, he's chill. He's like, I don't have anything going on. Everything's good. And, you know, so I was like, oh, okay. That makes me feel a little better. Cause he really didn't have anything to, to help him out in the, in the beginning of it all. So

Katie: 16:48

Oh, my goodness. yeah. I know. anyway, that's just also fascinating to me. I feel like because of CV CGMs, though, we are able to be a little bit more aggressive with our insulin delivery which. You know, then kind of makes the need for a CGM even greater, because if you're going to be a little bit more aggressive, you really need to see where those numbers are going. So

Rachel: 17:09

Yes,

Katie: 17:10

I

Rachel: 17:10

absolutely.

Katie: 17:11

yeah. Okay. Let's talk about, we're going to talk about the menstrual cycle. Everybody here we are. I know. All right. So what are the different phases of the menstrual cycle?

Rachel: 17:22

R right. I live to, if anybody has ever seen my Instagram, you know, it's just like constant, like period talk. I just love, I remember I, I became so obsessed with the menstrual cycle when they came in, I was in fifth grade when they came and talked, there was a, it was called girls Inc. And they're a fabulous little organization in Atlanta that. Kind of sets out to empower little girls and that sort of thing. And so they talked about the menstrual cycle and it didn't mean a lot to me at the time, but I did think it was really cool because I was like, this is amazing. Like our body like does this every month and we're like fixing a, grow something. And like, it's just insane. And I still am so thrilled about it every time. So when you hear me talk about periods, it's like, It's a good day for me, but

Katie: 18:11

probably the only one everybody else in the room was mortified. I'm sure.

Rachel: 18:15

I loved it. They give us these coloring pages of like sitting there coloring a uterus and it was just like, top-notch I loved that class, but It was just really cool. And I still think it's cool to this day, how, how our hormones work and what they're doing. It's a little as we'll talk about it. The uterus is a little vengeful, but in regards to the cycles, so like very quick rundown of it because yeah, I think they don't really teach it in like health class to my knowledge as they should, because it's something that happens to women every, every day, if you were at that point in your life So basically there's like two, two phases that you can kind of think of it as, and the first phase is what we call the follicular phase and it starts with your period. And so that day of bright red bleeding, and typically girls start this process around can be as young as eight or nine. And then ideally. You know, it could be as late as 15. You want to talk to your pediatrician if it, if we are at 15 and we still haven't gotten there yet, then that's. You all can have a conversation about, but it kind of is within that range and it starts with bright red bleeding, and that is a point of lowest hormones. So this is a really great time for girls because we get to eat all of the carbs during this time. You are. Insulin sensitive during your period, and maybe even a few days before the two players that you want to think about hormone wise during your period are progesterone and estrogen. Estrogen tends to make you a little bit more insulin sensitive and progesterone is the opposite of that. It's makes you very insulin resistant. That's the hormone we see during the second half of your cycle, as well as during pregnancy that causes all of that insulin resistance. But during that first half where you are menstruating, so days one through seven, that's going to be everybody's very low estrogen, low testosterone, slow. LH is low. FSH is low, it's all super low. So. Just you can I eat smoothie bowls and frappuccinos that whole week because I'm very sensitive insulin. It's super nice. That being said, you can kind of adjust your Bazell profile or your insulin to carb ratios. You may not really need a pre bolus during that first half. Because you're just going to be a little bit more sensitive to insulin. So like, I, for example, have a profile that's about 10%. Lower in every. Lower and basles and higher and insulin to carb ratios. And I use that on my period week. And then after you are finished with your period, you kind of go into a point where estrogen is going to rise a little bit among other things. Testosterone is also increasing as well. And typically. People notice they may get a little bit more sensitive during this time. But generally from what my clients have told me, and what we know about is just that people find this as like where baseline is. So this is a good time for like your basal testing and all of those things you want to, this is when your, your normal kind of baseline is happening.

Katie: 21:22

And that's the week after menstruation.

Rachel: 21:25

And so. Estrogen is increasing because we're preparing to obviate. So that's the release of an egg from the the little, what are they

Katie: 21:35

Fallopian tube

Rachel: 21:36

It goes into the fallopian. Yes,

Katie: 21:37

ovary to fallopian tube.

Rachel: 21:39

I'm like thinking of my coloring page.

Katie: 21:41

Yeah.

Rachel: 21:41

yes, you have eggs in the ovary, right? And so it's, it's getting to the point, it's kind of maturing in this little. Fall a cool. And eventually once we hit, it's typically around day 14 that we obviate physically you can tell the day of ovulation. Some, some ladies have some, a little bit of cramping and. Others notice. I think it's pretty common to have egg white discharge. This is the fun term for it. But it's yeah, when you hold down your underwear to go to the bathroom and you're like, why is this happening to me? What is this? That generally is because of ovulation. And that's just because your uterus, the uterine wall is getting thicker and it's getting to the point where it can Get that egg stuck on there is so that's why, why that is happening. So augmentation is the day that the egg is released from the ovary and into the fallopian tube. And this can last a couple of a couple of days then the luteal phase is just all of the fun hormone stuff. So the big player in this is progesterone, which is the one that makes us more insulin resistant. So when that egg has been released, the follicle that it was in turns into this little structure that starts releasing. Progesterone. And so your progesterone is increasing. And you were to get pregnant during this time, progesterone would just keep going and doing crazy shenanigans. you do not, then it's going to drop very significantly. And once it hits rock bottom, that's where we start over again and see the What we think of it's as menstruation. So yeah, that luteal phase is where you are going to be more insulin resistant, where your teen is going to be more insulin resistant. Just because of all that increased progesterone. So. Typically, I, you know, people we advise just increasing titrating about 10% in basles or insulin to carb ratios, wherever you're noticing that resistance start to happen. Until you just get to a place where you're like, okay, this makes a lot of sense. Yeah, so you September basles and, and you can do this with MDI as well. If you kind of are increasing the, the long acting insulin and your short acting insulin alongside it yeah, so your insulin needs will be. Quite a bit, probably about 20 to 30% higher during that second half personally. And I know a lot of my clients need like 50 to 60% more. So if you get to that point, that's okay. It's very individual. It just kind of depends, yeah, you, you will definitely notice needing a little bit more so you can adjust the insulin as well as the food you're eating. So just low GI kind of carbs. You don't allow salads all that good chocolate is a necessary thing. It has zinc, which is progesterone supportive. So that's why you are craving it. And you deserve all the chocolate during this time. So

Katie: 24:38

So interesting.

Rachel: 24:40

I know. Right.

Katie: 24:41

You guys I'm over here taking notes, like I'm in some sort of anatomy and physiology class and like,

Rachel: 24:47

book

Katie: 24:47

yeah, we

Rachel: 24:48

but yeah.

Katie: 24:50

It's very cool. It's fascinating. It's, you know, it's not something everybody talks about every day. So you know, apologize if anybody's feeling uncomfortable, but I just, it's just really, it's really fascinating the way the body works. And then to kind of see it reflected in your child that has type one diabetes by looking at their blood sugars. Like, it's just, It's just amazing.

Rachel: 25:12

Yeah. Well, and it gives you a little bit more. I don't want to say it's an excuse, but it gives me a lot of like comfort, like what, like the past week. I was, it was like that, that second half of my period. And I was so insulin resistant, like, I don't know what was going on this, this cycle, but my progesterone levels were through the roof and I was, I was so frustrated, and that's something you can, you know, if you're noticing like water is basically saline solution in my child right now, what the heck is going on? It's like comforting to check in and be like, oh, I

Katie: 25:46

you, mean insulin? you said water, but I know, you meant insulin.

Rachel: 25:49

Insulin is basically saline solution. but yeah. And that's, that's how it feels. You just like, keep putting, putting it in and it's just not doing what it's supposed to do. But it's comforting to be like, oh, okay. That's, that's what it is. It's not me. It's, it's just, it's the cycle that is happening and it's totally okay. And I can, I can adjust as needed.

Katie: 26:06

And you said for the most part, that insulin resistance starts to taper off like a few days before you actually start your period.

Rachel: 26:13

Right. You'll probably notice like a dip. Cause it just tanks it. That's why, I mean, your body has been dictated. It's like, I just built. This whole beautiful uterine wall for you. I don't have anything to show and it just tanks and, and then causes contractions. And it's just a total it's like, thanks a lot. And then it starts over because I guess it forgot or, or who knows, but anyway but yeah, typically you'll you'll, you may see that sensitivity come back and be pretty significant maybe a few days before period is supposed to, to start.

Katie: 26:48

I'm going to, I want to ask about birth control just because I'm curious. What if someone, what if someone's on birth control? Cause that has hormones in it. Hey there. It's Katie. And I want to tell you about our product feature of the weekMirabalm. The all natural adhesive remover we use to adhesive removers in this household. One is Unisolve. Which can be purchased on Amazon P S they also have a liquid version and I will leave a link in the show notes to both. And the other is Mirabalm. Look, I cannot say enough. Good things about Mirabalm. It smells fantastic and works amazingly well. This is what we bust out in the really sticky situations, like an overlay patch that just won't come off. Or that sticky black residue left behind after you remove the CGM or pod or infusion set, not only will you feel like you're having a mini spa treatment when you're changing out your gadgets, but Mira bomb is so gentle on the skin and actually replenishes your skin's natural oils that can get stripped off when you're removing your stuff. I will leave a link in the. That will take you directly to Mira bombs website, where you can learn more and grab a bottle to see for yourself. Now, back to my chat with. I'm going to, I want to ask about birth control just because I'm curious. What if someone, what if someone's on birth control? Cause that has hormones in it

Rachel: 28:10

Good question. So everything we just talked about. Basically would not apply. So if you're on hormonal birth control, it stops that that cycling of progesterone and estrogen and that good stuff. So it does actually, it may be like we typically will use birth control treatment for like PCLs, which is kind of It's basically when you, you just have too much going on hormone wise as a, as a typically we see that in people with uteruses and it just means that you are very, very insulin resistant because of this extra testosterone and progesterone that you're producing. And. we put them on birth control to help level level some of that out a little bit. So if you find that you are either someone with diabetes or taking care of someone with diabetes and that luteal phase is just traumatic in regards to cause they can be, it can be really difficult. To deal with and debilitating just depending on the hormone levels that are, that are going on there. So it's totally reasonable to use that as, as a way to we can use that as treatment essentially from the data that we have, there is not. Anything to suggest that birth control will affect your blood sugars negatively. So it would not make you more insulin resistant or really that much more sensitive. It just sort of levels that out a little bit. I do hear personally, like from, from clients though, that they sometimes notice that there are, you know, things that they, they have to go through a few different birth control. Choices before they find one that they feel like works well for them, whether that's like with mood or other symptoms or, or with their diabetes. So I don't think it's out of the question to suggest that it might do a little bit of something, but from the big data that we have right now typically our, our hormonal birth control is, is pretty low in, in hormone. It used to be back in. The early two thousands nineties prior to that, it was very high doses of like estrodiol and that sort of thing, which definitely would affect your blood sugars. But now what we have on the market tends to be a lot lower in like progesterone and that kind of thing. So ideally it should not affect the blood sugar negatively.

Katie: 30:39

So for girls who are maybe not going through puberty quite yet. So in the pre pubescent stage, about how many years before they actually start their period, would you potentially notice these cyclical changes with their blood sugar?

Rachel: 30:54

it can happen that a girl will obviate prior to that first period, from my understanding, it's not super common though. It can happen that, that, you know, you, you will see. Possibly some fluctuations, but it is not, not a super common occurrence. I think I would probably blame that more maybe on some, I guess if it's happening every month, but you know, probably some growth spurts or something like that, it would be my first guess. But it, it is definitely possible. And we do see that occasionally. I can't say though that it would, I would not expect it to affect. You in the sense of insulin resistance, because if you're obviating, that's more of an estrogen kind of fluctuation as opposed to that progesterone. So it's hard to say if that would, that would affect again, zero research on this. So it's kind of more of, of what I would put together hormone wise, but. When, when that first period does start though it is likely going to be very irregular and you may not see it doing what I just described. Blood sugar wise, I think the first year of, of a person's period, it would be they ovulate. One or two times out of, out of 10 of those chances to ovulate. So it's going to be just, just kind of how the body works for people with diabetes and people without it. And so generally after the first year or second year of having periods, it'll start to, to kind of level out and be more regular. But in regards to that observation prior to. That first period comes up. I it's, it's definitely, we don't have a lot of data to support kind of what would go on insulin wise. But I don't think it's out of the question to say that you might notice something because there really are a lot of things going on hormone wise. So you know, it's, it's totally reasonable to kind of think, okay. Maybe, maybe she is starting to ovulate even though we are, we're not at that point yet.

Katie: 32:57

So, anything else in terms of insulin needs for the teenage years, we've talked a lot. more about girls, but just because, you know, girls are a little bit more involved when it comes to body changes and cycles and everything. So anything else that we kind of didn't cover as far as insulin needs go for.

Rachel: 33:14

I will say it is important to know that. So big, big thing is going to be that, that insulin resistance that occurs there is something else that is going on where the. When the teen is going through puberty, they are more likely to decompensate quickly in regards to DKA. So super duper important to make sure that they are getting their long acting insulin regularly. If you, you know, cause I totally understand it's possible to accidentally skip it, but it does mean. They are more at risk to go into DKA very quickly than someone that is not going through puberty. Which is very interesting. And I always wondered about that because I would see a lot we see a lot of DKA in the pediatric hospitals, and I know I was always like, why didn't they just take their, you know, like if I skip a dose or something like that, I was like, I'll just take it, whatever. But it turns out that there's actually some of the processes that are going on, make them a lot more susceptible to. To reaching that point very quickly. So that's just something to consider, just making sure that we're getting that long acting insulin in. However you want to do that to remind yourself if they are wearing a pump. I suggest the steel infusion sets. Because again, it's. Those have like almost a no fail rate, right? So you're, you're always pretty much going to be getting insulin unless somehow you rip that thing out, which is really difficult to do. So that, that can be something that might be helpful if you have a. Active teen, or you notice that you have pods or something that sale very frequently. Just always making sure that you're checking and thankfully, you know, we have CGM, so it's very it's a lot easier to see those things, but just being aware that it is a lot easier for a person going through puberty to decompensate and go into decay very quickly compared to maybe what, what tolerance they had and how easily they could. Rebound from that in the past. So I thought that was really, I had no idea, but it makes a lot of sense now kind of what I was seeing in the hospital. It's very, yeah, it can be common.

Katie: 35:29

Hmm. Okay. No, I think that's great for parents to be extra vigilant or extra aware at least of during those times. I want to ask you about your camp experience before we sign off, because maybe just talk to the listeners a little bit about just what you can remember from your experience as a teen and going to a diabetes camp, summer camp. And then well, we'll start there.

Rachel: 35:53

Yeah. I think if you have access to a diabetes camp, it's super important, especially in those teenage years to. you're, you're already probably feeling as a, as a teen. I know, you know, you're, you're feeling fairly isolated and then compound that with having diabetes. It's just like a lot. So it's, it's very helpful to be around other people that are going through the same thing and to be surrounded by healthcare workers as well, that kind of specialize in it. We, at the time. That I volunteer at, do a lot of kind of education and things to, to help, you know, this is a time of transition as well for, you know, parents and, and that teen is kind of giving them a little bit more independence in regards to managing themselves, which can be, I know it's. It's probably very terrifying. But yeah, so that kind of helps to have it a little bit of a neutral party come in and do a little bit of talking and showing how to do certain things.

Katie: 36:53

is that part of most camp? Correct. You know guess curriculum makes it. makes it sound academic, but do most diabetes camps incorporate like a. Kind of like little, little lessons, like little type one lessons on, okay. Now you're becoming more of an, an adult you're you're getting ready to launch into adulthood and let's make sure you know how to manage this. Well.

Rachel: 37:13

Yeah, I think for the, at least the ones that I. Observed and seen in Georgia that there are little like kind of age-based activities and trying to go through and talk about those things as it, as it becomes important. I find, especially in the young adult, kind of like that 1918 sort of we do the sex drugs and alcohol talk, which is So thinking important and often. And we just, we don't talk about it. And especially when you're going off to college or something like that it's something that needs to be discussed. So yeah, it's, I think it's, it's fairly common in those camps to have a little bit of. Transitional education to sort of help at least tell them I loved, I loved kind of learning. It was very significant for me as like a, it's funny, like an eight year old to kind of understand why I was doing it because I was diagnosed so young. I didn't really know. The only thing I knew was that it was different than other people. But I didn't know why. So they, they made it kind of like a friendly way of, of describing kind of what happened to my body and why I was doing what I was doing. And that was really like personally, I've always, I'm a control freak and want to know why this is happening. So yeah, it's, it's, I think that's really valuable in a lot of the camps do that. So

Katie: 38:33

Well, Andrew, you're having a lot of ridiculous amounts of fun, Right. Like you guys do a lot of ridiculous camp stuff too.

Rachel: 38:38

Right. Absolutely. Yes. And I think that's most of what they pay attention to. I do know

Katie: 38:42

Um,

Rachel: 38:42

had teen boy. I always had like I had young adults two years ago and then this past summer I had the teen boys. So they were like 14, 15, and y'all, I. had no clue how I, I got there and just, I have 16 boys that I have to get ready for meals. Right. Like, that's the clinician's job, which is insanity. And I, I tried to, like, I was like, here's the table with the, in, you're going to carb count this, here are the menus. And I gave them calculators and I was like, come to me when you are ready. And you know, and they come up and I was like, did you count the carbs? And they're like, no. And I was like, what are you, what are you doing here? But anyway, so it's like, This is like a, they were so cute, but I was giving these boys like 50 to 60 units of insulin for their meals and they were just hanging out in the two hundreds and I'm like, what is going on? I honestly had no clue the effective growth hormone until this past summer. I was like, holy cow. Um, yeah, so lots of it was, it was insanity and it was really scary. To do that because they're just so small still, you know, it's like, should I really be giving you all this insulin? And so that was really interesting to see it from, you know, having all of those, those boys in there, they're having a very similar experience. And uh, you know, eventually by the end of camp, you kind of get them all figure out what's going on. But yeah, it was insane how much insulin they took and

Katie: 40:15

And still up still elevated.

Rachel: 40:18

Yes. It was crazy. I couldn't believe it. I was, I was shocked. I was like, I'm losing my license. Like, there's no way they're going to go, oh, they're going to all go low today. And I'm, I'm so screwed. But yeah, they just like hung out in the two hundreds and it was just crazy. And I I had boys on pumps and long acting insulin, you know? Cause they had such a significant need for, for that insulin during this time.

Katie: 40:41

Oh my gosh.

Rachel: 40:43

Yeah. And but they're just so cute. I, I just loved them. But I did, this is, I went off on a tangent, but I know when I was providing education, we were talking about. Why it's important to stay in range. Right. And kind of going over the complications long-term complications. And I just like, kind of gave them, I was like, Y kidney failure is something that I find is personally for me, very scary, having worked on like a dialysis unit and that sort of thing, and seeing what, what had happened. And they took it. And so every time their blood sugars were above target, they'd be like, miss Rachel, my kidneys are gonna fail. They were just trying to torture me. I don't think they were super concerned about it.

Katie: 41:23

I know what's 15, 16 year old boy is really thinking about their kidney function.

Rachel: 41:28

right, right. But I hope that because they spent that whole summer torturing me that, you know, someday they'll be like, okay. Yeah, I do need to, I do need to make sure that I'm I'm in range because Ms. Rachel told me

Katie: 41:40

Of course they will. We all grow up one day. They're gonna wake up and they're gonna be 24 years old and they're going to be

Rachel: 41:45

Yeah,

Katie: 41:46

I should probably pay attention to what Mr. Rachel told me

Rachel: 41:48

right, right.

Katie: 41:49

camp and take care of my kidneys.

Rachel: 41:52

It was too cute. It was just maybe love.

Katie: 41:54

They are, that is a fun age. I don't have teenagers right now. My oldest is only 11, but I, for about three years, I volunteered with the middle schoolers at my church. And they're just like, They are painfully awkward, like in a great, hilarious way. And they're D and that was just so endearing to me, like

Rachel: 42:11

Yeah.

Katie: 42:12

completely awkward, especially those sixth graders. Oh, my word. So awkward. That's not even teenage years, so I'm not sure why it's talking about it, but it's just those middle school and high school years are,

Rachel: 42:23

Yeah.

Katie: 42:23

fun. Cause they're just, they don't know who they are. They're trying to figure it out. It's.

Rachel: 42:28

I loved it. They were just too funny and they're using like gen Z flying, you know, and I just it was cracking me up. Another. Yeah. It's just like the other problem. Of course. Especially, I noticed this with kind of, I was, I was talking to the clinician that was working with the teen girls and they wouldn't eat. Like, they were so moody, like for lack of a better stereotype, but they, they just, they looked upset to be there and they were just, you know, they were like, it wasn't that they weren't hungry or something. They just didn't like the food basically. And they were like, I'm not going to eat. Whereas my boys were like, Seven slices of pizza. And I was like, no, you're not, absolutely not. Like that would be like a hundred, some odd units and we're not doing that. But I think that is, you know, something to kind of consider as a parent when you, you know, you'll likely see that they want to eat more, but they're also more insulin resistant, which can be a lot. So it is important to kind of talk with them about it and, and come at it from like, Based. So that's what I would, I was like, okay, well, instead of seven slices of pizza can you think of maybe something that would help fill you up that is not pizza? Like like the salad looks really awesome. And, and maybe if we get through that salad and you're still hungry, you know, we can do another slice of pizza, but try to, you know, trying to work with them and, and validate that I get that you're so Stang and hungry, but and I would tell them to, you know, if, if your blood sugar. So elevated. I, you know, we won't be able to, to go on that bike ride that we were going to do because I have to watch your, make sure you don't you know, we have to get your blood sugar down before we do any heavy exercise like that. And that, that kind of just connecting that to the, the things they enjoy so that they can make those choices that honor their overall health. Can be, can be helpful as opposed to just giving an eating seven slices of pizza.

Katie: 44:23

I'm just keep thinking about giving somebody, anybody, 60 units of insulin, and then having them go run around at camp. Like you're going to go swimming in a lake after this. Like how far apart do you spread out the meals in the activity?

Rachel: 44:37

Not far, and that that's what would happen. They would call me and they'd be like, oh, Rachel this, this kid is like 40 now. And I'm like a, Betty is like, he didn't eat all of those seven slices of pizza. Like he told me what and you know, so stuff like that would happen. I was trying to take a nap because the counselors are for the, the counselors. The clinicians are up to. Three in the morning we do the midnight checks and they have to be at a certain point before we can let them go to bed. So it's this like all night affair. And then we wake up at seven in the morning to go do breakfast again. And so we don't get any sleep. It's so I've been trying to take a nap and I hear somebody walkie talkie, either. Like know Rachel, we gave so-and-so. Three juice boxes and some glucose tabs. And he's still in the thirties. And I was like, oh my God. So, and my blood sugar is low at this time, but I was like, I gotta fight. I grabbed a glucagon gun and I ran down there and I mini group to this child. And, and then he, I was like, yeah, my blood sugar is low too. So many glutes myself, and we're just sitting there. But I think that, again, it, it just kind of a. It's that idea that these things happen and it's a side effect of insulin and you always have the tools you need. Like the, the kid thought mini glucagon was the coolest thing in the world. And I was like, I totally agree. It's like, I don't have to sit here and Chuck, any more juice boxes? Like here we

Katie: 45:56

Yeah. Wait, who makes this? Is this the red kit you were telling me about? And the six day sick day management

Rachel: 46:01

Yeah.

Katie: 46:02

need to get a red kit, which is like the old, old school glucagon where you can like microdose the gluten.

Rachel: 46:09

Right. So we use that a lot at camp because they are so active. So especially at night when you people tend to be more insulin sensitive and all of that activity is hitting them. You know, I'm like throwing chocolate milk at them and but it sometimes if it's very persistent we do use like a little bit of subcutaneous. So in the, in fat, instead of muscle glucagon, which we call mini gluc and that just helps bring it up to a reasonable level. If, if all that you are trying is not working. So that's a great tool for sick days, or if you have like a really active kid or something like that. They come home after a football game or something, and you're just like, there's just nothing. That's going to keep their blood sugar above target. That can be a really helpful tool for sure.

Katie: 46:56

Okay. All right. I don't go back to the end. We don't go back to the endocrinologist until January, but maybe I'll Just message her through the little

Rachel: 47:04

yeah.

Katie: 47:05

like a portal I'm going to do that. Let me do that today.

Rachel: 47:07

want some, I want some old glucagon and be like, why

Katie: 47:11

Expired. No, no, no. Just old, you know, the old kind, none of this fancy

Rachel: 47:15

this scary looking kid that's what I want. It is. It is really, yeah. It just looks like disturbing. Why is it like this? But it is, it's very versatile. You can kind of mix it up.

Katie: 47:26

Yeah. All right. Well, thank you so much. I feel like the world is getting a little bit more back to normal, so I'm hoping to see some summer camps out there for kids of all ages with type one to actually go in person because I mean, bless their hearts. The virtual was an attempt, but let's be honest. It just is not.

Rachel: 47:44

it's definitely not the same.

Katie: 47:45

Not the same at all these poor teens and kids with type one, they need to connect with people in real life. So, Yeah, All right. Well, thank you so much for coming on today. I guess I should. I just want to make sure before we leave anything else you want to say? Anything else you want to add?

Rachel: 48:00

I think that's it. I did put a. I put like summary of a bunch of studies for teens and type ones in the chat over here. So if you want to put that in the show

Katie: 48:13

I see.

Rachel: 48:14

can read it. It's very, it's got a lot of medical jargon in there, but if you're someone who enjoys kind of it, it goes over a lot of the physiological processes processes of what's going on. So it's an interesting thing to read. But yeah, that's kinda kind of the basis of. What you'll experience, but if anyone has any questions, they can always message me or of course, talk to your doctor about it. It's very common experience for them. I'm sure.

Katie: 48:40

You know, I did have one more question. Just what, what, what age do things kind of start to settle down for now? I feel like for girls it settles and then they might go and get, you know, go have, start to plan a family and then they're pregnant and then the whole rollercoaster starts over again. But as far as the teenage years go around, what age do things start to settle in terms of blood sugar?

Rachel: 49:00

It's typically once puberty ends. So that's kind of nice. that's actually fair. Like for, I think for it's around like 14 years old and for guys it's around 15, 16 or something like that. So yeah, once they kind of are done doing all that growing. You're you're off the hook from,

Katie: 49:23

We're done.

Rachel: 49:25

I'm just getting back and there, there may be certain, you know, again, it may vary and be pretty individual, but for the most part, all of that, growth hormone increase kind of, it basically stops doing what it was doing. they, once they reached that end of puberty.

Katie: 49:43

Carol you hit the nail on the head. I was just Googling It Well, when I asked you in Google, cause I mean, duck, Google is clearly the doctor of choice. This is. from family doctor.org. So I feel like it's probably fairly reliable, but Yeah, it says most girls finished puberty by age 14. Most boys finished puberty by age 15 or 16, which that's surprising to me. I, you would think being an adult and a girl and going through all of this myself and, and having three children, I would be a little bit more aware of like, you know, puberty and the menstrual cycle. But I learned a lot today. Thank you, Rachel.

Rachel: 50:19

right. No, it really, I was surprised by those. I had, I looked them up a few days ago because I wasn't entirely sure, like when does puberty end and I always assumed it was kind of. Like eight. Yeah. Yeah. I really did. Or like 18 or something like that. Cause that's how it felt personally, you know, felt like it took forever. But yeah, technically hormone wise, it's, it's a lot, a lot sooner, so that's really nice.

Katie: 50:45

Then it's just the growth hormone from there on out that causes all these crazy. For the most part.

Rachel: 50:49

Yeah. I think there's still some, some growth spurting and things like that, but From what I, if you kind of look at that article, it did say it, it seems to kind of taper off after puberty ends. The majority of that insulin resistance, at least.

Katie: 51:02

Yeah. Well, I guess 15, 16, that was the age of the kids you had at camp. So, yeah, that would make sense. Why there.

Rachel: 51:07

can't, I can't believe that they were, I hope it wasn't worse for their parents, the beginning of that experience. Hopefully by the time I see them next, they will be leveled out a little bit.

Katie: 51:18

Yeah. All right. We're just going to go into survival mode through those however many years. What? Four or five? Six years. Buckle up buttercup. All right, I'm cut. I'm closing in on it. It's coming up soon for me.

Rachel: 51:30

So exciting.

Katie: 51:31

I guess is it? I don't think it is Rachel.

Rachel: 51:34

You're right. You're right. And I just, again, I guess I, I just focus so much on, on how cool hormones in the body is. Like, that's kind of where I come from. I'm like, yeah, this, this sucks for, from the diabetes perspective, but like how cool is this, this person is growing. it's just so awesome.

Katie: 51:50

love it. You're such a nerd and I'm here for it.

Rachel: 51:54

It's going to find those, Little what is it? Silver linings.

Katie: 51:57

Absolutely. No, I agree. It is definitely fascinating. And while I hate that my daughter has type one and I would prefer that she didn't. I Yeah. it's definitely interesting to see how just emotions in general, aside from, you know, teen puberty stuff affect people's blood sugar. So it's just crazy to think that all of that is going on in my body too. And everybody else's body, it's just, we don't see it reflected in our blood sugar. So.

Rachel: 52:20

Right. Absolutely.

Katie: 52:23

All right, girl, we're going to go ahead and sign off. I feel like we covered a lot and I think it was really informative. I think it's going to be really helpful to the listener. So thank you so much.

Rachel: 52:32

of course I enjoyed being here,

Katie: 52:34

Well, you have a fabulous day. Bye.

Rachel: 52:36

thank you. Bye.

Katie: 52:38

All right, that's it. For our episode today, I will leave a link to the summary of the studies on T1 D teens. That Rachel mentioned though, that will be in the show notes. And I will also leave a link to where you can find Rachel on social media have a fantastic week and I will chat with you soon. Bye.