Is it true that in poorly controlled diabetes, growth hormone levels are often higher than normal? Does that mean if your child’s control were too tight, your child would not grow as much? Would your child grow taller if his blood sugar were not so tight?

It is true that many states of “relative starvation,” including poorly controlled type 1 diabetes, anorexia nervosa, and others, are associated with higher basal serum growth hormone (GH) concentrations. In some of these conditions, the higher GH has been postulated to be a compensatory mechanism: GH is a glucose regulatory hormone and promotes higher glucose levels. In poorly controlled type 1 diabetes, for example, although there is plenty of glucose in the serum, most cells of the body see little of it because there is lack of insulin to facilitate the entry of the glucose into the cells. This has been called “starving in a sea of plenty.” Subsequently, the body tries to compensate for this lack of glucose recognition by perversely activating the mechanisms to increase serum glucose, one of which includes increased GH secretion. Still, there are suggestions that during some types of induced starvation, the body becomes relatively resistant to the effects of GH, hence, GH is higher and its effector hormone, IGF-1, is low.

Ideal glucose control, along with good health, will maximize a diabetic’s growth in height. Good control does not stunt growth. It was previously observed that new onset type 1 patients tend to be “taller,” but poor glycemic control does not promote better growth in height. It is possible that those earlier observations of taller new-onset type 1s was really a demonstration of poorer weight-to-height ratios, given the typical weight loss that precedes a diagnosis of new-onset type 1 and accompanies a diagnosis of poorly controlled type 1 diabetes.

DS