Variability of Total Daily Dose of Insulin in Type 1 Diabetic Pre-Menarchal vs Post-Menarchal Females

Abstract Study Objective Quantify the change of insulin requirements in pre- vs post-menarchal adolescent females with type 1 diabetes (T1DM) by measuring the total daily dose (TDD; units/kg/day) of insulin administered before vs after menarche in order to provide anticipatory guidance of insulin requirements in adolescent females as they progress through puberty to help reduce the long-term complications of poorly controlled T1DM. Design/Setting/Participants A retrospective chart review study was conducted which included 52 adolescent females with T1DM, after subjects who were diagnosed with T1DM after menarche, those on hormonal contraceptives, or those that had hypothyroidism, major medical comorbidities, or incomplete records were excluded. Subject demographics along with body mass index (BMI) percentile, HgbA1c (hemoglobin A1c), and TDD of insulin were collected 0-2 years pre-, 0-2 years post-, and 2-4 years post-menarche to assess differences in TDD of insulin in pre- and post-menarchal adolescent females with T1DM. Interventions None Main Outcome Measures TDD of insulin at 0-2 years pre-, 0-2 years post-, and 2-4 years post-menarche in adolescent females with T1DM. Results There was a statistically significant difference of TDD of insulin in pre- vs. post-menarchal adolescent females with T1DM after controlling for HgbA1c and BMI. Conclusions While poor glycemic control is often attributed to adolescent non-compliance of insulin administration, a physiologic process similar to polycystic ovarian syndrome may induce insulin resistance in post-pubertal adolescent females with T1DM.