My 15 year old son has had diabetes for nine years in poor control despite our best efforts, and his growth has slowed down. He had a bone age x-ray two weeks ago to see what growth potential he has left. His consultant thinks his growth maybe blunted since his puberty is well advanced. How common is this? What can be done to help him? Can growth hormone be given if his bones have not fused yet?

In general, one of the most common reason for poor growth is hypothyroidism although it also occurs in some rare disorders like the Prader-Willi syndrome.

Poor diabetes control, especially during early puberty, may retard the child’s height development and decrease the growth spurt during puberty. Puberty may be delayed, and girls may have irregular or missed menstruations.Years ago, it was common for children with diabetes to be stunted in their growth due to Mauriac Syndrome.

It’s very important to consider both insulin and nutritional requirements in relation to the child’s growth phase. In fact, during the puberty years, when the body is developing quickly, the need for insulin is increased and you will often need to increase the doses considerably. Levels of growth hormone in the body increase. If you give too little insulin during the years of growth spurt the final height will be one or more centimeters less than predicted. Use of a basal/bolus injection regimen or an insulin pump may be very effective in promoting better growth.

The eventual use of exogenous growth hormone therapy needs a consultation with an endocrinologist.

MS