#556 Diabetes Variables: Growth Hormone

October 8, 2021Scott Benner

Diabetes Variables: Growth Hormone

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to Episode 556 of the Juicebox Podcast.

Something kind of weird happened, and I'm going to share it with you. So this is a diabetes variables episode. It's about growth spurts. But it may or may not surprise you to know that Jenny and I record a number of variables in a sitting. So I have a little list. I say, hey, Jenny, next up, I'd like to talk about growth spurts, then we talk about it, we don't pre plan we just have a free flowing conversation. Now to prove that, I'm going to share something a little embarrassing with you, Jenny, and I only record about once a month. There's pretty big gaps of time in between when we see each other normally. So we did growth spurts, and I forgot to cross it off my list. So they ended up on my list again for the following month. Neither of us remembered that. And we ended up doing and we ended up doing this variable twice. And I'm going to leave both versions in here for you. So you can see the differences right in between the conversations and they did go differently. It's very, very interesting. I mean for me, and I hope for you as well.

This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juice box. Let's not forget to Jenny is just a person who comes on the show, but she has a real job she works at integrated diabetes comm if you want Jenny can help you with your diabetes. That's not an ad. It's just me saying I love Jenny and I want to help her. Okay, get ready, you're going to hear the same variable twice. Alright, I record I hit record. Hey, Jenny, I want to talk about a variable today. growth spurts. And I think that I think that probably is going to lead into hormones too. And puberty. So I feel like they may go together. Am I right about that? Or no?

Jennifer Smith, CDE 2:24
You say because they all have to do with growth hormone and changes in the body? And yes,

Scott Benner 2:31
okay. So the reason it comes up as a variable in my mind, and this is from me, being able to watch people interact online, is that, you know, children get diabetes at all ages, obviously. But the younger ones, eventually their parents kind of get into a rhythm and things are just like, working right? And then all of a sudden they see on their graph at a certain time of the night. This just never ending upward trend of blood sugars. And, and that's why I think it merits its own variables episode. Yeah, absolutely. Because it comes out of nowhere and they don't know what to make of it. Is there an age? There's not right, like it could happen to you. I mean, I'm sure there's an age range, but when to like let's start with boys, when the boys start hitting puberty.

Jennifer Smith, CDE 3:25
Honestly, I mean, the range I would honestly say is probably somewhere between 10 on the very early age range, 12 ish, 13 ish most likely, all the way through potentially like that 18 to 20 because boys can grow longer, give or take boys can grow for a longer period of time than girls. Girls typically grow visibly like in height especially girls typically grow up until about the age of 1617 ish. Boys grow a little bit longer than that. So I would say anywhere between 10 to 20 as a very wide range and probably more like 12 to 18 out of on a shorter range

Scott Benner 4:16
for boys the Google magic here tells me that people don't know either because they're people Google you know can a 12 year old can an 11 year old can a 10 year old boy hit puberty and so I thought well why don't I just like go over some signs of puberty. That way you don't have to worry about the age so much but then what came up is hilarious so laughing instead of first signs of puberty and boys. This is a great this is such a strange sentence the first sign of puberty in boys is usually that their testicles get bigger and the scrotum begins to thin and red. So I don't know how you're gonna check on that.

Jennifer Smith, CDE 4:51
Right exactly unless you've got you know a very like comfortable like you know family I don't know and or you take Do the doctor and you say I'm not comfortable looking at this, could you please check this out for my child?

Scott Benner 5:04
Right? Because I was hoping for like, you know, shoulders brought in or just look at that you could just kind of look at you know,

Jennifer Smith, CDE 5:12
yeah. And I don't know I mean for boys, another sign is often times that voice change starts right? Like some crappy voice, some deepening of the voice from the, from the kid to sounding voice which, you know, my little guys still obviously have they're only four and a half an eight and a half. So they still obviously have that like little kid. But that's another typical for boys. I mean, some that occur in both boys and girls are obviously like, some underarm hair and like hairier legs and that kind of thing.

Scott Benner 5:53
I will say for moms, I think you can, the way your son smells starts to change you like that's it. That's a good one to look for

Jennifer Smith, CDE 6:01
when they start to need deodorant. Right? You're exactly right. When they start to need deodorant. They have a definitive funk after they're done playing an hour of soccer, you know?

Scott Benner 6:13
Yes, yeah, yeah, I don't I want to be clear, I don't think you should like tell your kid Hey, if you're when your testicles start getting bigger, and you're screwed them, what does it say? begins to thin and red. Yeah, I don't think that's a good way to go. But so but when you see that the indication to you around diabetes should be there are going to be more growth hormone now. And so we're going to probably have to meet that with insulin. But does the Why does that impact? Why is that impact so obvious overnight to so many people? Is it because that's when growth really happens? What do you think it can be that some people's overnight basil rates or a week or two, like that just popped into my head?

Jennifer Smith, CDE 6:53
Well, I know that you know, we actually have, Gary actually has in his thinkbook a really nice chart that actually defines sort of insulin needs through the life cycle. And it goes from like infants, kids teens, into like adulthood, and then older age people. And what we actually find is that kids and teens have the highest insulin needs overall, you know, if you're completely opposite, it doesn't opposite of this, it doesn't necessarily mean anything's wrong with you, it's just the majority of kids and teens will have a much heavier base basil need overnight. And it often then sort of dips down a bit kind of comes through the course of the day, whereas adults, and definitely older adults, often have a lower bass diesel overnight. And then it kind of nudges up a little bit more at certain times of the day, especially that morning time period, right? hormones in the teen years, I think are they're heavier in terms of visible insulin need. Because once you get to the point of being 10 plus years old, you're most likely if you've been living with type one for a number of years already, you're most likely already at a point of more insulin than you were as a little kid. And so then the hormone impact on top of a rate that's let's say, already, like one unit in our teens might go up to 1.4 or 1.8 2.1. I mean, the amount of extra insulin needed from a hormone standpoint, during that whole team growth cycle looks really heavy, because your base often starts heavier already. Whereas where your little kid, you might have a basil of point one, five, and it goes up to like point three. And yeah, that's, I mean, that's a big shift. But it's not as dramatic as like, the bigger doses, right?

Scott Benner 8:55
Yeah, it's why that I know, I've said a couple of times, and I hope it doesn't seem pejorative, but you know, when you're managing a seven year old really well, that gets almost like diabetes training wheels, a little bit like yours, there's still a lot more coming in, you need to know that, that it's on its way but I think more importantly, when you see it, you need to be able to react to it and just understand it, you know, what happens that people see and they're like, oh, something magical is happening, and I don't know what to do and you know, like, and they get all flustered, instead of just saying, well, there's a need here for more insulin, let's just meet it. Yes, and I do understand that. The can the concern can be it's the first time you've seen it. If I come at this very aggressively, what happens if I'm wrong and I'm too aggressive then on the other end, we see some sort of a drop. But I mean, after you notice these things over and over, and again, you have to you have to get ahead of them. Right? You know, and

Jennifer Smith, CDE 9:47
they will happen or and it to say over and over again is really important because they will happen over and over again. And again. If you've had a child who's had or a teen who's had diabetes since they were younger, you've already seen As a more sick, let's call it nature to hormone shifts, growth cycles and this you get to a point of insulin need and then it shifts again. And then it shifts again and then it shifts again. Well, kids grow and they keep growing.

Scott Benner 10:16
It's waves to its waves. And it doesn't necessarily have to happen when you think like there was a time for a long time that Arden was the smallest girl around like she's five one she weighed 70 pounds, like, you know, that kind of thing. And our I mean, I think Arden's done growing now but aren't five seven, you know, she's one of the tallest girls in the town we live in. I mean, so much so that if she meets people like guys that used to coach her softball team when she was little she can they don't even know it's her. You know, like she's

Jennifer Smith, CDE 10:50
okay she is taller compared to her little petite. Yes, pretty self.

Scott Benner 10:55
And when I go back and look, sometimes it was weight. Sometimes it was height sometimes she started maturing at one point she was rather curvy. She is not anymore like it. It went through a lot of different shifts. Yeah, seasons. By the way, Jenny, signs of puberty for girls. Why do they use words that make me want to giggle breast buds? buds, okay, right? pubic hair, which they listed for the boys. But after I said, fitting and reading, I didn't. armpit armpit hair for girls again, acne could be an indicator. And then a higher growth rate. I guess when girls start growing tall, they they keep going. Right? And then what I mentioned earlier, I said kind of curvy, but hips thighs, you start getting Yep, you start getting fat and all the lady places. Yeah, like not fat, like,

Jennifer Smith, CDE 11:50
well, you just I guess another term is like you fill out really, you know, you go from really a kid based, very, like, I call them like square bodies, kids have like, really no hippie, kind of there's they just started like, straight down from like armpit all the way down their legs, they're just this like rectangular box. And I've got like good visibility of it. Like, with my third grader, he and his friends have like, grown considerably over the course of the summer. Like just seeing them now in these first couple of weeks of school, the differences in the heights of kids and whatnot, but they all have boys and girls, they all have this straight, like rectangular box shaped like part of their body. And then once puberty hits, that changes and it's especially visible for girls as you know, breast development kind of comes into the picture. And hips kind of change and shift and wait, especially for girls who may not have the best like nutrition plans or the you know, maybe activity and the best types of foods, they can tend to during that puberty time game more than they may actually need to because the hormone shift is causing a lot of shifts in hunger and you know, the appetite and the way that their body is sort of maneuvering change.

Scott Benner 13:18
Let's I want to add a couple things here and we'll stop but my son's like 21 and a half now and he texted me the other night. Hey, I just I just squatted 375 pounds. I'm like really? Please don't hurt. Wow. Yeah. And and now I realize that even just a handful of years ago, even though he was a strong athletic kid, I still could have manhandled him if I needed to do you know, like, not that that was our situation. But if if it went down to me, I think I could have taken care of it. And, and now, I'm pretty sure that if that happened, he would just grab me by my face, and he could just like throw me out of the way if you wanted to. Yes. And so point is don't be worried. Yeah, well, he's still maturing. Like I know that's a weird thought. But he looks it was this spring we went out on the baseball field for the first time and I said this is the first time I feel like I'm having a catch with a man I actually told this was the very first time I've had that feeling. And he was a college athlete prior to that, right you know, and so but that was the first time he looked at me and his shoulders were bigger and his chest was broader. And you know, I thought oh, this is I'm out here with another guy get on it. It's not a kid anymore.

Jennifer Smith, CDE 14:31
Well, that's why I said you know, guys can tend to grow and some of that growth is more like I said about like, the early teen girl like filling out. Guys, especially if they're really paying attention or they're into a specific sport or something. They tend to plus 18 years, they get that fill out, their shoulders brought in a little bit more their body actually kind of gets more to the point of like, like visible structured

Scott Benner 15:00
He talks about weird ways that I think my he goes, I think my frame can handle about 205 pounds. Like he's like 190. Now when he was trying to gain weight, but it's interesting the way he, like, you're right, like athletes think about it in a different way I do. I'm always like, I wonder how much thinner I can get. I would like to not look like you know, I don't want to have like fill out and but my fill out is different because I'm 50. And let's, let's just add at the end that a birth control pills. Yep, can can mimic all of this right?

Jennifer Smith, CDE 15:33
They can I mean, and again, most most girls are not really started on birth control until there's a visible issue in terms of their normal menstrual cycle during the teen years. Right. And or you think that there's definitely a purposeful reason for birth control, right. But most often in the teen years, it's because the cycles are very irregular, or very heavy, or very, very painful, almost kind of like a debilitating type of you know, pain. So then birth controls bring in another level of like hormone, but many times with birth control for the women who things have not been as regular, the regularity that's brought in because of them can actually make blood sugar control a little bit easier in terms of the cycle. Some birth controls can contribute to some weight gain, and some of the newer ones on the market and or the adjustments to the doses and whatnot for for what women need. The can be just kind of stabilizing, they won't necessarily cause gain or loss. Yeah.

Scott Benner 16:42
So Arden had to do it for reasons that you just mentioned, irregularity having, like etc. and took us a couple times I'm still not sure we found the right one to be honest. So yeah, like I mentioned to you before we recorded like she has like a she's not she's hungry, but she can't like imagine what food tastes sounds good to her. She also is having trouble stomaching meat. And there's part of me that wonders if it is maybe a birth control pill? That's because does it mimic you being pregnant in some way to and doesn't sometimes like that happened with foods? I mean, I could be

Jennifer Smith, CDE 17:17
wrong during pregnancy? Yes, during use of birth control, it essentially continues to cycle you through without oscillation. So there is no potential for pregnancy because it just shuts off the ability to obviouly right. I mean, that's a general statement.

Scott Benner 17:34
But my question was that does. Is there anything about taking the hormones that gives you similar situations to like, when you have cravings when you're pregnant? Or maybe I'm just maybe that's not right. I

Jennifer Smith, CDE 17:45
don't believe so. I mean, not from anything that I've seen with the women that I work with, nor that I've necessarily read about in terms of cravings, if anything, because it's stabilizing hormones, or should be more to keep a regularity to the cycle. Usually, most women have the same types of cravings the couple days before their period that they would have even if they weren't on birth control, like the salty sweet kind of like could eat anything and then maybe the rest of the time, their appetite is just kind of back to normal.

Scott Benner 18:22
Yeah, so it's interesting. I've experienced it now twice in my life once dating and once father and the child. It's a different feeling like in both situations, but it's really interesting you ladies are very, very interesting people. Okay, yes, we are like I could, I could spend the rest of a couple of lifetimes probably not understand what it is I'm looking at still.

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Jennifer Smith, CDE 20:52
I mean, for the most part, yeah, a lot of children's growth in the hormones that impact growth happen into the after bedtime time period. And while kids overall insulin needs are higher overnight, in general, that's pretty typical. So even on the nights that kids aren't in a growth phase, you know, with increase in hormones, most kids still have a rise in blood sugar after they go to bed. But it's not as profound of an increase as during a growth phase. And there are other like, cues, you know, you said, well, has your child gained weight, are they a little bit taller, a cue to me of just my own kids who don't have diabetes, but I know when they're going through growth, because it's visible in what they eat. And their sleep or their like fatigue level. So both of my kids will eat and eat and eat. I mean, kids eat right, but they will eat more, like they will get asked for like to burn breakfasts, they're kind of like habits when they're growing. It's like at first breakfast, second breakfast. First one, you know. And other times, like my little guy, right now, he's definitely in like, a stable time period. Because his breakfast I have to, like, urge him finishable finish your breakfast, you know, whereas usually it's down in like, four minutes, it's gone. You know, so that's something visually to pay attention to, too, because if you're going through that, you can say, Okay, I'm going to expect an increase in need.

Scott Benner 22:41
My son, when he was going through his real growth, time, you know, 12 years old, 13, like through there actually, boys are usually a little later, but his calves would get bigger, and then he would get taller. That's what happened every time. So it was just the craziest thing you'd watch his calves get bigger. And then we'd say a coal is gonna get taller soon. And then he would. And I funny that you noticed this cow. is a baseball players always insurance. He never Okay, he's never wearing pants. So it was just one of those things aren't in sleeps more. You know, when when her body is going through changes? I mean, but but I guess the it to bring it back to diabetes for a second. Its growth spurts is a weird thing. Because yes, yes, I just my tongue just came out of my mouth didn't go back in at the right time. Yes, I was like, Am I having a stroke is this but but yes, growth spurts cause your insulin needs to change. But it's a throwaway answer online when people don't know what to say. Like, what is this? Oh, it must be a growth spurt. Do you mean like, it's one of it's one of the diabetes. You know, I'm saying buddy. Like, I get that vibe. And I think at least if people can see it, maybe then they won't write off other things as being a Grossberg if that makes right. You know what I mean? Yes.

Jennifer Smith, CDE 24:08
Well, and it also goes along with, as we know, experience, right? If you are newer in a diagnosis of diabetes with a child, there are things that you'll have to experience to be able to see what to do and what the impact for your child or teen is gonna look like. Right? And then you then you use that as you move forward. You use those experiences to kind of build on, but if you've been doing it a while, and it's always a throw your hands up in the air.

Scott Benner 24:41
Yeah. Yeah. So I'm probably gonna talk myself out of downloads here. But the truth is, if you came to me and said, Scott, I want to do a variables, episodes about diabetes. And you came on and you said, Hey, Scott, today's topic is puberty and hormones. What do you think? I'd say? Yeah, insulin needs changed. You should just Be flexible and change with it. But then I would say that in every episode that was sort of, like the, in my heart, and I think at the core of what makes the podcast valuable for people is, I don't really care why your blood sugars are doing what they're doing. Just meet the need with insulin and move on is But still, when you're in the moment, it is. Listen, it's not only necessary, it would be difficult to try not to diagnose things. And so I love these valuable episodes. I'm being a little facetious. I love them because it gives people something to go Oh, like, maybe they're growing. Like, I don't know, a ton of technical stuff here, like, your kid might grow and need more insulin. Give them more insulin, don't stare at 220s overnight for a week and go I don't know what's going on. Because, you know, because maybe it's a Grossberg give them more insulin but right maybe an aliens flying in their room and giving them sugar to if that's give them more insulin, like care why

Jennifer Smith, CDE 26:00
it's happening. Probably bigger problems there then just

Scott Benner 26:03
better window locks at the very least. So that's the kind of overnight like, while your body's making it, blah, blah, blah, like, right, like you're, it's giving you things you're building. But don't overlook the idea that as the body gets bigger, if you're being medicated with something, you're going to need more there's a reason your doctor asks you how much you weigh. When you when you go, I remember having a surgery one time. And Jenny, this is uh, not exactly a humble brag, but I don't look my weight to most people. And so I go into get a surgery. And you know, they get they give me the medication, and they come back in the room, the pre op room, and they're like, are you okay? And I'm like, yeah, I'm great. What's up, like, you should be half asleep by now already. And I was like, feel good. And then nurse picks up the chart looks, looks, looks, looks looks, how much do you weigh? And I told her, and she goes, Oh, oh, the doctor thought you weighed much less. And then

Jennifer Smith, CDE 26:59
they didn't check your weight before you show

Scott Benner 27:03
her Am I is this gonna go Okay, you know, but the part I took from it was that because of my body weight, I needed more medication. And then the same thing happens here. If your body weight goes up, you're probably going to need more insulin and, or right maybe, but it's worth looking into it because I've talked about here before, but it beat us in the butt before when Arden we finally got Arden's thyroid medication straightened out. And then she got bigger. And suddenly she's having these terrible symptoms. And our brain didn't say thyroid, because we thought we fixed thyroid already, right? So then we're taking her to heart specialists, when it turns out what she needed was like 15 more micrograms of terrorists, or something, you know what I mean? Like, so please look at that. Growth and growth spurts.

Jennifer Smith, CDE 27:52
Well, and I think the big thing too, that you kind of touched on. But more specifically, when kids grow, they don't, they always up grow, they don't down grow. If your child is growing, you will need more insulin and likely more insulin in that time period of growth, be it two or three days be at five days. Usually growth phases are not extensive, right in terms of like a month long amount of increase. But you will also find because of the growth, your baseline insulin is not where you're going to land back to, after the larger need for growth, you'll usually find like a middle ground between the low need the high need for growth, and now you're settled in after the growth. That's kind of where you're gonna aim to get to.

Scott Benner 28:46
So there's a spot where your basil is at where even your meal needs your correction factors. And then during the growth, they're going to increase. Yes, but they may drift back down. Lower from where the growth is happening, but not all the way back down to where you began. Correct. Excellent. Cool. Thank you.

Jennifer Smith, CDE 29:06
Yes.

Scott Benner 29:12
A huge thank you to one of today's sponsors. g Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGL Uc ag o n.com. forward slash juice box. Let me do a little round up here at the end of the week. dexcom.com forward slash juice box omnipod.com forward slash juice box Contour Next one.com forward slash juice box touched by type one.org. Trial net.org. forward slash juice box. Those are the sponsors hit the link support the show I hope you enjoyed that kind of little look behind the curtain. It's never happened to me before. And when I realized that it happened, I thought, wow, this is super interesting. And I first I thought, I'll just delete one of them. And I'll give them the other one. And then I listened through both. And I thought, these are fundamentally different conversations. And such a good indication that Jenny and I really do sit down and have off the top of our head conversations about stuff like this. And I think it's interesting to see how the conversation can be drawn in different directions, just by somebody asking a question, or having a thought one day that they didn't have the next. That was really cool. And it gave me an idea. So in 2022, Jenny and I are going to go back privately, separate of each other, and listen to a diabetes pro tip episode. And then we're going to come together the next day. And we're going to record an update to the diabetes pro tip. And we'll do that all through the year in 2022. How cool is that? Right? I think that's gonna be really interesting and fun. And I think valuable. I really think we might look back at ourselves from a couple of years ago and say, Oh, I would have I should have said this here or since then I've learned this And now I'd like to expound a little bit. Anyway, that's a little teaser. That's gonna be a long while from now, but it's something to look forward to. Alright guys, seriously, thanks so much for listening. I love making this podcast. I'll be back soon.