My daughter has been having joint swelling and pain in the ankle and knee. She is scheduled to see a rheumatologist soon and is currently receiving physical therapy to reduce the pain and to avoid medication. Her endocrinologist said that “they blame everything on diabetes,” but all other physicians say it is related. Her grandmother has Crohn’s. All initial blood work came back fine. Could the swelling be related to her diabetes? It has been going on for about two months. She is in puberty and has gained several pounds lately. Her A1c is 8.7.

Her glucose levels are very high, as reflected by her elevated A1c, so she is at risk for all acute and chronic diabetes related conditions. But, the joint swelling that you describe is generally not seen with type 1 (or type 2) diabetes. There is a type of non painful joint stiffness called limited joint mobility, but this reflects glucose making the skin taut and stiff. Joints are actually normal. There is a mild increase in juvenile rheumatoid arthritis associated with type 1 diabetes but this would require some positive arthritis related antibodies or other blood studies. Also, if she skips insulin frequently, she can have swelling of extremities, but not just one joint. This is often associated with recurrent ketoacidosis, limited joint mobility, liver enlargement, delayed puberty and much higher A1c levels. So, I would assume this is unrelated to her diabetes and would evaluate her rheumatologically as well.

SB