<s>[INST] hello, my daughter is almost 10 years old. she has been a diabetic for almost 9 years. she has been pretty controlled up until a couple of months ago. we adjusted her pump and the past week has been horrible. 450 to 37 in 2 hours. does this have to do with maybe puberty starting already? [/INST] Hi.... usually puberty doesn't cause hypoglycemia like this. I feel it is more possibly related to the recent pump adjustment. I suggest you get back to the endocrinologist or diabetologist regarding this.Regards - Dr. Sumanth </s>