I have a 14 year old girl that has been diagnosed with Addison’s disease and type 1 diabetes. She has come to our office seeking an insulin pump. When reviewing her log book, she runs higher than 200 mg/dl [11.1 mmol/L] most the time, but will bottom out randomly. Her total daily dose (TDD) is about 100 units. I am interested in finding out if insulin resistance is common with Addison’s disease, or, if she is being over insulinized and feeding insulin all day to prevent lows. She is 5’6″ and 126 pounds and is half African American, half Caucasian. She denies any weight gain or loss. Her A1c is 9.9.

I hope that this teen is being seen by a pediatric endocrinologist since this is quite complicated to manage. Most youngsters do not need such high doses of insulin, so it is very likely that she is omitting lots of her insulin and then intermittently taking too much causing such hypoglycemia. The same could also be true for her adrenal replacement and/or thyroid replacement. It may be very helpful to talk to her pharmacist to get pill and insulin counts since this would give you some idea of whether or not your prescriptions are even picked up let alone refilled. The risk of death from ketoacidosis or severe episodes of hypoglycemia in such circumstances is very high so this is a highly dangerous situation. Long term complications risks are also quite high. Has there been any testing with transglutaminase antibody for celiac disease and with gastroparietal antibody for malabsorption of vitamin B12, folic acid, iron etc.?

SB