August 23, 2006
Aches and Pains
Question from Delmar, New York, USA:
My daughter just turned 18 last week. She was diagnosed with type 1 in January, 1998. For the past two weeks, she has been having a burning sensation in her upper arms, chest and back which has been getting progressively worse. Yesterday, this feeling was all over her body. There was also some muscle pain in her upper thighs and, just the past few days, a feeling that she has to urinate. She also has a high pulse, 130 to 150, but normal blood pressure, 117/70. She also does not sweat at all. Last week, the temperatures were in the high 90s and she did not perspire at all. I took her to Boston for her birthday and all she did was sit down every time there was a bench and didn’t really have a good time. She cries all the time because of the pain and the frustration of wanting it to stop and wondering if her poor control in the past is causing this.
She has not had good diabetes control. She also has weight issues. In June, she went on an insulin pump and had an A1c over 14%. She weighed 91 pounds and looked awful. Since being on the pump, her A1c has dropped to 8.7 and her weight was 108 pounds. Since she hasn’t been feeling well, her weight dropped to 103 and she is slowly losing her appetite because of the pain in her skin. She had blood work done on August 4 to rule out Lyme disease as well as check some other things. Her liver function tests were better than they’ve been in a long time although she does have a fatty liver. Nothing else was out of the ordinary. She’s currently taking 0.75 mg of enalapril twice a day and 60 mg of Cymbalta. On Monday, the nutritionist and pediatrician lowered the dose from 90 mg thinking that might help. It has only been two days on the lower dose, but the sensation is worse, if anything. She had a urine culture test to rule out a UTI on Monday the 7th which came back negative. The doctors don’t think it is neuropathy.
On June 5, my daughter broke her wrist in two places and just got the cast off on July 19. She was feeling better and exercising, walking, swimming and lifting weights (three pounds) until the burning sensation started in her arms and chest. The pediatrician said to stop for a while as she had no muscle from before. Now, she can’t stand to wear clothes or have anything touch her. She has no desire to go in the pool as it is hard to go up and down the ladder and the cold water “hurts.” I’ve tried to get her to walk in the evenings when it is cooler, but she said she is too weak.
She currently sees a psychologist for the weight/body image issues and anxiety about college. She will attend college locally, but will be living in the dormitory on campus. She moves in on August 26.
I am so frustrated and none of the doctors have a clear idea of what is wrong with my daughter. Do you have any ideas?
Answer:
Unfortunately, it is impossible to diagnosis this over the Internet, but if you say that she has had years of poor glucose control it is likely diabetic neuritis/neuropathy. Perhaps she is also depressed, anorexic or bulimic as well, if she has problems maintaining her weight. The good news is that improved and sustained improved glucose levels will allow the body to do a great deal of healing, but never very quickly. The bad news includes all the symptoms you describe. I would encourage her continued close work with the psychologist/therapist and close contact with the diabetes team helping her. Consultation with an expert in diabetic neuropathy may also be helpful, although the medications for such painful neuritis are not so great. There also should be some evaluation of the other causes for such pains including thyroid, adrenal, vitamin deficiencies, celiac disease, and mineral deficiencies since these are treatable.
SB
