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Type 1 Diabetes and Puberty

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Insulin deficiency impairs growth during puberty as it influences growth and development hormones. Read below to know more.

Medically reviewed by

Dr. Nagaraj

Published At May 25, 2023
Reviewed AtJanuary 6, 2024

Introduction:

Type 1 diabetes is a chronic condition, also called juvenile diabetes or insulin-dependent diabetes. In this condition, the body can no longer produce its own insulin. In normal individuals, the islets of Langerhans in the beta cells of the pancreas produce insulin. Millions of islets of Langerhans are present in the beta cells. Insulin is made from the beta cells in response to a high level of glucose, amino acids, and fats in the body. The main cause of type 1 diabetes is an autoimmune reaction where the body’s own immune system destroys the beta cells of the pancreas. In rare cases the cause of the disease is unknown. Genes are less contributing factors to juvenile diabetes, while any exposure to viruses and environmental factors can cause this condition where the insulin-producing islets of Langerhans are completely destroyed.

What Is Type 1 Diabetes?

  • Type 1 diabetes has no permanent cure and the only way is to provide the patients with exogenous insulin. These exogenous insulins are available in the form of insulin pen injectors, needles, syringes, and inhaled insulin.

  • Without exogenous insulin, there is a sudden spike in the blood glucose level. In the absence of supplemental insulin, diabetic ketoacidosis will occur, which ultimately leads to coma and death.

  • If the problem is not treated properly it leads to blindness, kidney disease, and nerve damage can also occur. If the patient has frequent hypoglycemia, they are given insulin through pumps that provide a continuous supply of insulin.

  • Very low blood glucose leads to fatigue, anxiety, confusion, and loss of consciousness.

  • Basal insulin analogs are preferred over human insulin (neutral protamine Hagedorn). Any rapid-acting prandial insulin analogs are preferred over regular human insulin for mealtime insulin.

  • Latent autoimmune diabetes is a form of Type 1 Diabetes mellitus in adults that involves a slowly progressing immune-mediated loss of beta cells.

  • Proper identification of the condition is crucial because these patients need immediate insulin therapy and reach optimal glycemic control to prevent further complications like diabetic ketoacidosis and microvascular and macrovascular complications.

  • Type 1 diabetes symptoms are feeling thirsty, urge to urinate more, feeling hungry, weight loss, tiredness and weakness, and blurry vision.

How Does Type 1 Diabetes Affect the Puberty of an Individual?

  • The incidence of type 1 diabetes peaks at puberty. Insulin is responsible for the metabolism of the body. The lack of insulin causes the disruption of GnRH (growth hormone-releasing hormone from the hypothalamus) neuronal function.

  • In diabetes Mellitus patients, the extra fatty acids and glucose combine with proteins and lipids that circulate in the bloodstream.

  • The increased levels of glycation end products suppress the activation of Growth hormone-releasing hormone from the anterior pituitary gland.

  • The follicle-stimulating hormone, luteinizing hormone, and testosterone are low in type 1 diabetic patients when compared to nondiabetic patients.

  • Juvenile diabetic patients experience pubertal delay and growth retardation due to poor glycemic control and associated chronic complications. The factors that influence the growth are:

  1. Age.

  2. Environmental factors.

  3. Growth hormone status.

  4. Insulin-like growth factors (IGFs).

  5. IGF binding proteins.

How Do Hormones Influence the Growth Pattern of an Individual?

The hormones affect the growth of an individual in the following ways:

  • Growth is a complex phenomenon that is affected not only by growth hormones, but it is influenced by androgens, glucocorticoids, thyroid hormones, and insulin.

  • In humans, there are two periods of rapid growth, the first in infancy and the second in late puberty, just before growth stops.

  • The first period of accelerated growth is partly a continuation of the fetal growth period, which is not influenced by the presence of growth hormones.

  • The second is a period in which hormones from the gonads and the adrenal glands combine with growth hormones to produce the adolescent growth spurt.

  • The factors influencing human growth are classified into three main categories, i.e., endocrine glands, heredity, and environment, as well as genetic and environmental factors.

  • Insulin is essential for maintaining the responsiveness of the liver to growth hormone (GH). Insulin deficiency decreases liver GH receptor (GHR) expression, which can be reversed by insulin administration.

How Does Growth Hormone Influence the Production of Insulin?

Insulin affects the growth hormone in the following ways:

  • Growth hormone is a vital hormone that has to experience a series of processes to fulfill its function, including secretion, entering the circulation to reach target tissues (pre-receptor process), binding on the GH receptor (GHR), and triggering signaling inside cells (post-GHR process).

  • Insulin can directly or indirectly influence part of these processes. GH secretion from pituitary somatotropes is regulated by GH-releasing hormone (GHRH) and somatostatin (SS) from the hypothalamus.

  • Insulin may exert positive or negative effects on the neurons expressing GHRH, SS, and somatotropes under healthy and pathological conditions, including obesity and diabetes. Glucose and lipid levels in circulation and dietary habits may influence the effect of insulin on GH secretion.

  • Insulin may also affect GHR sensitivity and the level of insulin-like growth factor 1 (IGF-1), thus influencing the level of GH.

  • In type 1 diabetic individuals, there is profound dysregulation of the metabolism of nutrients. Puberty starts with the release of sex hormones estrogen in girls and testosterone in boys. These hormones raise the child’s blood sugar level.

  • Meanwhile, the child is growing, filling out, and building muscle, so they must eat more. Altogether, these changes mean they’ll need more insulin during puberty.

  • In diabetes patients, the insulin is low or completely absent, so the glucose uptake by the muscles and cells is reduced, which makes the child grow very slowly, and eventually, they attain puberty very late.

Conclusion:

During puberty, the production of growth hormones increases and is associated with increased growth velocity. In diabetic patients, the growth hormone increases blood glucose levels, and the high blood glucose is counteracted by insulin. In severe insulin deficiency, the glucose uptake by the muscles and adipose tissues is impaired, eventually affecting the growth during puberty.

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Dr. Nagaraj
Dr. Nagaraj

Diabetology

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