January 6, 2001
Daily Care
Question from Kota Kinabalu, Sabah, Malaysia:
Our three year old daughter was diagnosed with type 1 diabetes two weeks ago. She was admitted in the hospital for 10 days. Prior to her admission, we noted that she had large amount of urine at night and feel thirsty very frequently. Her condition was getting bad as we noted she became less active, tired and lost her appetite. Now her condition is much improved and we are doing glucose monitoring at home four times a day: pre-breakfast, pre-lunch, pre-dinner and pre-bedtime snack. Her sugar level is still not very stable (between 5 to 25 mmol/L [90 to 450 mg/dl]). We are delivering her insulin using the Novopen 3. Her insulin is 5 units of Mixtard pre-breakfast and 3 units pre-bedtime snack. We have several questions:
Type 1B might be free from insulin dependency especially for non-Caucasian individuals. How can we test this over here?
Since she is still very young and has been detected early, what can we do for her to minimise complications later in her life?
For better control, is it advisable to get into insulin pump as soon as possible?
Answer:
The only way at this stage to tell whether your daughter has type 1B or idiopathic diabetes rather than type 1A or autoimmune diabetes would be to get an antibodyA1c level without insulin.
I do know of one three year old who is successfully controlled on an insulin pump, of the Swiss Disetronic firm. In general, this step is best deferred until the pre-teen years and in any case it needs to be supervised, at least to begin with, by an experienced diabetes care team.
The best prevention of long term complications is to maintain meticulous control of blood sugars, a subject that is rather beyond the scope of e-mail to describe in detail.
DOB
