July 16, 2005
Diagnosis and Symptoms, Other
Question from Elk City, Oklahoma, USA:
My nine year old niece has always had respiratory problems and started seeing an allergist five months ago. He put her on steroid inhalants and oral steroids for asthmatic problems. Two months later, she became very sick and lethargic. She was taken to her pediatrician and had a blood test which revealed a very high blood sugar. Then, she was sent to Texas Children’s Hospital and put in the Intensive Care Unit on an insulin drip. She had lost 12 pounds in a month and was down to 52 pounds. They diagnosed her with type 1 diabetes and started her on insulin injections.
It is now three months later and she is only on one unit of Humulin in the mornings and is running low to normal blood sugars being tested at least four times a day. There is no one in our families with diabetes and she is a child that has been limited to very healthy foods throughout her life with very little junk food or sugar. My sister has been having to increase her carbohydrates steadily to keep her blood sugar up high enough. When this child’s parents inquired about this they were treated like they were in denial and told she was in the honeymoon phase. They have researched this and understand this phase, but it doesn’t make sense to them to have to give their child more sugar so they can give more insulin. She is eating more carbohydrates now than she ever has. Is the research being done about steroid induced diabetes making any headway? What would be the best way to test her at this time to be definite of this diagnosis. Also, are children ever misdiagnosed?
Answer:
Steroid induced diabetes usually happens in one who is genetically so predisposed. It does sound like a honeymoon phase and we usually continue small amounts of insulin, with food to balance the insulin, to save the remaining pancreas’ beta cells and to minimize insulin allergies if the insulin itself is discontinued. Having nobody in the family with diabetes is common, so, this is not a factor. The foods that you mention, healthy or high sugar content, do not cause type 1 diabetes, so, this is also not a factor.
If your family is unhappy with the care or information that they are being provided, they should seek a second opinion from another pediatric diabetology team. Another option is to have a scheduled consultation appointment with the diabetologist and be prepared to ask these detailed questions so that they can be satisfied of their understanding. If islet cell or GAD antibodies were checked at diagnosis, you will also know if this is the underlying autoimmune cause and the steroid treatment, while appropriate, merely tipped the scales.
SB
