Does anyone have experience with their T1D child also having a failure to grow (currently diagnosed as idiopathic short stature)? My 12 year old is to undergo a growth hormone stimulation test, which is 5 hours and for which she will have to fast 12 hours prior. Just wondering 1) if anyone has experience with this test or other tests that require fasting while having T1D and 2) if anyone has experience with growth hormone therapy in a T1D child? Thank you.
Cary @caryb, I’m not at all familiar with the Growth Hormone therapy or testing, but I am familiar with extended fast before procedures - I’ll share a couple of thoughts based on my personal experience fasting before surgery on a few occasions.
- I request that surgery is scheduled “first thin’” in the morning;
- I do at least one “practice run” where I awaken at the hour I’d need to get up on the procedure date - keeping in mind the adrenaline surge that may cause significant BG rise;
- If your daughter uses an insulin pump, create a pump Profile/Pattern that manages her body glucose level - I suggest a little higher than “normal” - that will extend for the entire duration of the procedure;
- What to watch during the practice runs - either by frequent finger-stick or CGM: tendency to test below 90 mg/dl or rise much above 180 or her normal after breakfast high.
If she uses MDI for her management and takes a background/basal in the evenings, the evening dose MAY need to be reduced; and any bolus correction in the morning should be at a reduced percentage of what you calculate. I use a Tandem t-Slim x2 pump and set the “mode” to exercise which attempts to keep BGL close to 140 mg/dl - a very safe level when being put to sleep for surgery.
Discuss your plans ahead of time with the procedure provider and with your daughter’s diabetes professional. The testing team should be told that a BGL of xxx [say 200, is not unsafe] during a procedure especially as your daughter WILL BE anxious and excited by the unknown.
My best wishes for her, and for you
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My experience with fasting for tests has been 1. so the food does not interfere with bloodwork or 2. to prevent vomiting during surgery.
Like Dennis I schedule my procedures for first thing in the morning, but in reality something scheduled for 8am still may not take place until a couple of hours later. 17 hours is a long time to go without eating - diabetes or not - hopefully you are able to find settings or timings that keep your daughter steady, but as backup you might ask for options in case you need them: I’m not familiar with the type of testing you refer to but it may be that liquids would be okay in lieu of solid foods for instance. Hopefully they can make some accommodations if not as a matter of course, as a “just in case.” Be sure you have it in writing from the prescribing doctor to avoid problems when you get to the testing facility.
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Hi @caryb fasting is easier with a pump but you can do it on shots as well. I like the test run advice @Dennis gave because you can try it low risk. It is important for the doctor to understand and advise on low blood sugar because she will need access to fast acting carbohydrates. For surgery where there is a strict “no food no water” fasting protocol I have just used glucose tabs because they dissolve completely in minutes and the sugar directly absorbs into the bloodstream.
The growth hormone test involves administering a growth hormone stimulant (injection) and then measuring for growth hormone (a blood test) several times. My child (not T1) had the procedure done almost 3 years ago it was slightly unpleasant. He also was given food afterwards which he immediately vomited. It took about 4 hours afterwards to feel better. Good luck 
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Hi @caryb in addition, my son didn’t qualify for growth hormone treatment because they said his reaction to growth hormone stimulant was normal.
My niece went through the process and qualified (they diagnosed her with deficiency) and I think it’s a shot every week or couple of days. Subcutaneous shot just like insulin. The growth hormone is very expensive. She got great results because her bone age allowed a year of treatment.
Sorry I didn’t include this in my original response. Good luck
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@joe thank you. I appreciate the extra information. My daughters bone age is significantly younger than her chronological age so we are also thinking we have some time, but want to get the test soon. I wish we had done it before the T1D diagnosis. She also was diagnosed with Celiac the year prior so we had thought that may have been the reason for the growth delay, but growth has not improved unfortunately.
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Hey! I don’t have direct experience with this, but I can imagine how challenging it must be to balance T1D with something like a growth hormone test, especially with the fasting involved. Managing blood sugar during those times is definitely tricky. I’ve heard that careful planning with the care team is key—maybe they can adjust insulin or snacks leading up to the test to keep levels stable.
As for growth hormone therapy, I came across this article that might give you some helpful insights: [HGH Injections]). Hopefully, it’ll provide some useful info while you navigate this process. Wishing you and your child the best!
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@DavidNich Welcome David to Breakthrough T1D Community Forum!
As far as the 12 hour fasting, I suggest the same method she would use whenever having other procedures, such as need for anesthesia. What I do in those situations, and it is not difficult for me while using an insulin pump, is to do a practice beforehand and watch what happens - and make adjustments from that experience.
If you share some more about your daughter’s method of managing her diabetes, we might be able to provide some more helpful tips.
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hi, another suggestion … you could run this by your endocrinologist … please think about checking ketones during / after this fasting test (the practice run also). If she is not eating for 12-17 hours, she might run into a carb deficit, use fat instead, and produce some ketones. Even if her blood glucose numbers stay excellent, it’s still possible to form ketones. If you test, you will be able to jump onto the ketones as soon as possible and address them rapidly.
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She is on Omnipod 5 and Dexcom and recently was able to start using the automated mode on Omnipod. I was thinking I would set it to activity mode (target BG150) for the duration of the test.
the test is coming up next week!
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@Caryb Ask your daughter’s Endo for a plan for insulin dosing for fasting and the test. Not all tests that require fasting require a plan from an Endo but GH stimulation testing does. There over 100 different protocols for GH stimulation tests and some involve dosing the patient with insulin, others glucagon, over time which would be complicated for a T1D with a pump so on testing day don’t forget to have your daughter tell every healthcare professional she encounters at the testing location she is a T1D.
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Updating for anyone who might need this resource in the future. The test went great. I set her omnipod to activity mode and she did absolutely fine! The protocol involved administering arginine (which can affect blood sugar) and one other medicine that does not really affect blood sugar. Her blood sugar started out on high end of her range and was pretty stable for the test. Thanks for all the advice.
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