From Fortaleza, Ceará, Brazil:
My nephew (15 years) was diagnosed with Type 1 diabetes one month ago. His glucose was very high during the first three or four days (510 at the first glucose test), but since he began to have the correct diet and regular exercise his glucose is never higher than 100. He's taking 7U of insulin in the morning and 3U at night. At first he was supposed to have 12U a day, but as the glucose was coming down too low he began to have only ten, and since than it has been at a well level -- 70 to 100. What are the chances he has to become cured?
I'd like to know when islet beta transplantations will be able to be done here in Brazil or even at USA and about the possibilities and conditions he has to have a successful surgery. I'd also like to know if, having a well controlled glucose level, he may have problems like heart disease, kidney failure, nerve troubles, etc? I'm a doctor (anesthesiologist). I'll be pleased very much if you answered these questions for me as completely as possible. Thank you very much!
Your nephew is currently on a very small dose of insulin which almost certainly reflects that he is going into what is called the honeymoon period during which his own pancreas is still producing a significant part of his daily insulin needs. This usually lasts a few weeks; but may be prolonged for several months after which his total daily insulin needs will usually rise to around 0.8U/kg.body wt/day if he has the typical autoimmune form of Type 1 Diabetes. Recently it has been shown however, that over half the new-onset Hispanic children in the US have a milder form of diabetes where insulin needs continue to decrease after the initial phase to the point that these children may ultimately be controlled by oral hypoglycemic agents or even by diet and exercise alone. There is often a strong family history and at least some of these children have one of the several types of hexokinase deficiency or MODY2 (Maturity Onset Diabetes in the Young).
It is very unlikely that your nephew will ever be cured of his diabetes; but with good education in diabetes management and family support and continuing good control of blood sugars he should nowadays be able to look forward to an essentially normal, albeit disciplined life. If he turns out to have one of the milder forms of diabetes the task will be even easier. I have not incidentally been able to find any comparable figures to the Hispanic ones for children with a Portuguese background. Getting a precise diagnosis at this stage may be difficult and in fact is not all that important because management is the same whatever the type. You might however like to call 1-800-425-8361 in the USA to see if they can give you any information on a laboratory in Brazil that can do antibody studies. If these are positive, he will have the autoimmune form of diabetes and if not, then more likely the milder MODY form.
Progress with islet cell transplantation is very slow although great efforts are being made to solve the problems. At the moment whole pancreas transplants have something like an 80% survival at five years; but they would not be considered for a 15 year old because of the need for long-term immunosuppression. In the very best hands, islet cells have only a 25% survival at one year.
Your nephew might find Understanding Insulin-Dependent Diabetes by H. Peter Chase, M.D. a useful manual and it can be down loaded free from www.uchsc.edu/misc/diabetes/bdc.html. It is written for a rather younger age group, but might be fine for a 15 year old who does not have English as a first language.
Original posting 16 Jan 98
Last Updated: Tuesday April 06, 2010 15:08:56
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