From California, USA:
Six months ago my 13 year-old son was told that he had type 1 diabetes. He had flu symptoms and his blood sugar was 300. The doctor put him on a 1200 calorie diet with no fruit or milk. He had him take 7 NPH and 7 Regular twice a day. He continued getting sicker and we changed doctors after a week. The new doctor reduced the insulin until he was off of it. His blood sugar was in the 80-100 range without insulin. We took him to an endocrinologist and the HbA1c test was 6.5. All other tests showed only a trace of diabetes. The antibody test was positive. She increased the calories to 3000 and he now has fruit and milk. His readings have been in the 70-90 range. When he exercises he feels sick and gets tired fast. At night his sugar level is in the 40-50 range. He lost 40 pounds since this began.
They checked the thyroid and ran many other tests but he still continues to lose weight. They said this is a honeymoon stage. I am confused; please offer some insight before my son wastes away.
The initial high blood sugars, positive antibody test and insulin dependance certainly confirms that your son has Type 1A Autoimmune Diabetes. The continuing loss of weight, the easy fatigability and the apparent ability to manage without insulin requires further explanation however. Without knowing what the 'many other tests' involved my first suggestion would be to ask your son's doctor whether, when the antibody tests were done they included tests for anti 21-hydroxylase to detect adrenal insufficiency and anti glutamyl transferase or anti transglutaminase for the celiac syndrome. It is quite possible that your son has what is called the Autoimmune Polyglandular Syndrome which is an autoimmune disorder involving more than one system. Type 1 diabetes is a common component and so is hypothyroidism; but the celiac syndrome may occur in up to 10% of cases. Involvement of the suprarenal [adrenal] glands is much less common but would explain the weight loss, the easy fatigue and the fact that blood sugars have been quite low despite the lack of insulin. This component like the diabetes itself may have been triggered clinically by the initial infection.
Another and to my mind rather unlikely consideration is that the problem is nutritional. Generally speaking giving a 13 year old a 3000 calorie diet doesn't mean that that is what he will get and if the above suggestions are eliminated it would be useful to talk to the dietitian in the team about collecting a three day diet record and having this computer-analysed to see exactly what he is getting.
Finally, it does seem possible that psychosocial issues are playing some part in this unusual response to the early management of the diabetes and it might be helpful, if there is a medical social worker in the diabetes team to ask for his/her help in trying to disentangle the problem.
I hope this will be of some help and in the meantime I would feel some urgency about excluding adrenal involvement, especially as it is easily treated.
Last Updated: Tuesday April 06, 2010 15:09:10
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