From Newfoundland, Canada:
We have two children. Our first child developed diabetes when she was 3 and now she is almost 7. Our baby developed diabetes when she was only 2 and now she's almost 4. There is no family history of Type 1 diabetes in any of our families. Could you please explain how this happened with no history?
Also, our doctor wants our girls to go on Lispro; we are really scared to make the move. Is there enough research done about the new insulin? Is this a safe move for our little girls?
The inheritance of Type 1 Diabetes is somewhat complicated in that the genetic component only confers a special susceptibility which then has to be triggered by an environmental factor in order for the full autoimmune response to develop. What the genetic component does is to define certain proteins on the surface of some of the white blood cells, which in turn decides whether these cells can properly distinguish 'self' and 'non-self'. These defects are usually very specific involving the joints in rheumatoid arthritis and the insulin producing cells and occasionally other endocrine cells such as the thyroid in Type 1 Diabetes. These environmental factors have so far not been defined, though many viruses have been suggested and until recently early exposure to cow's milk was a strong contender.
In the case of your own family, the children must have inherited a 'high risk' HLA type from you or their father or even from both of you. What has been different has been either the particular HLA combination or the degree and timing of the environmental exposure. It is incidentally possible, though not at all likely, that you or your husband do indeed have Type 1 Diabetes, albeit one of the forms that do not become insulin dependant until much later in life and in some cases perhaps not at all.
On the issue of Lispro insulin, this modification of Regular insulin has been used in our clinic and in this age group since it first became available, and there have been no specific problems. The main difference in comparison to Humulin is that it has a shorter and more precise span of activity starting ten to fifteen minutes after injection and lasting not more than four hours. You can mix it with ordinary Regular insulin or with NPH, and you can dilute it in saline or the special Lilly diluent provided you then use it right away.
Perhaps the most useful advantage is that it can be given right after the meal, which means that you can adjust the dose for pre-meal blood sugar and for appetite, sometimes a real advantage at an age where activity, appetite and stress levels can be very volatile. A commonly used intermediate step that you might think to discuss with the children's diabetes doctor would be to continue using Regular insulin in the morning with the idea that its longer action would cover the mid-day meal better; but to use Lispro in the evening to cover supper. Again with the idea that its action would be over by bedtime and therefore less likely to contribute to the risk of hypoglycemia during the night.
Original posting 18 Feb 97
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