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July 16, 2010

Other Illnesses

Question from Peebles, Ohio, USA:

My daughter recently had a butterfly/malar rash across her face. A subsequent positive ANA test produced a diagnosis of lupus. We are awaiting an appointment with a pediatric internist to determine if her lupus is systemic or only skin involved. I am unsure what to ask the internist or what records I should get from the endocrinologist to take to the internist to help with the diagnosis. How common is lupus and type 1? We have been watching her thyroid as well and her T3 was at 5.

Answer:

Lupus added to type 1 diabetes is actually quite rare even though both are autoimmune disorders. It is likely they have different genetic sites that set up predispositions. There is more thyroiditis and thyroid disorders in patients with lupus, however. The rheumatologist who you should be seeing to help manage the lupus should be able to get all the information needed from you and your child’s history of diabetes without many details needed from the endocrinologist since there is not much overlap. If prednisone or other steroid is needed to treat the lupus, this will need to be co-managed because the prednisone type medications will dramatically increase the insulin needs within 4 to 8 hours of the first dose and keep the sugar levels elevated for as long as the prednisone is provided. If no prednisone is needed, then the other medications usually will not have dramatic effects but blood glucose monitoring will let you and your medical team know. It will also be important to know, if the lupus is confirmed, whether or not there is kidney involvement or other organ involvement since there are mild and more severe types of lupus. Having the rheumatologist and the diabetes team confer will be very helpful.

SB