October 23, 2009
Question from Norwalk, Ohio, USA:
My 14-year-old son has had type 1 for almost five years. He uses an insulin pump, and other than crazy sugars last year at the onset of puberty or during an illness, he usually has all the numbers under control. In January 2009, he got a stomach virus then, after about three weeks was still vomiting in the mornings, constantly pooping, and constantly eating. We thought he had a tape worm. Let me also say that his sugars were all over the place during this time, but mostly high. After five months of enduring doctors and specialists and every test under the sun, he was diagnosed with low pancreatic enzymes. He was placed on a supplement (Pancrease) and, within two days, we saw an improvement. He was great all summer, went back to school and immediately got a stomach virus followed by strep throat. He has had VERY high blood sugars ever since and the same symptoms as before. We have worked closely with our specialists and have gotten his sugar under control. Also, he has had no ketones during ANY of these times. However, on school days, when I wake him up at 6:15, he is still vomiting, has a horrible headache, and sugars over 200 mg/dl [11.1 mmol/L]. He has to take Zofran to calm his stomach and it takes him a couple of hours to feel better. He has already missed 13 days of school and the school year just began. I am wondering (1) – if anyone knows of any correlation of type 1 and any other disease that could cause these pancreatic problems and (2) – what I can do to prevent these morning sicknesses. On the days when he can sleep later, 99% of the time, he does not have these vomiting episodes. Could this be something going on with his sugar in the middle of the night or early morning that is causing his sugar to get out of whack? Any information would be helpful. Please note that we recently got lots of blood work and are waiting for results, and are working closely every day with our endocrinologist and gastroenterologist.
I assume that he has been checked for other problems i.e., celiac disease, GERD, Crohn’s and other inflammatory bowel conditions, parasitic infections, etc. Occasionally, odd thyroid problems or adrenal insufficiency as well as pernicious anemia can present in this fashion so these should also be checked. These are more common than a pancreatic enzyme deficiency. The latter is not so commonly seen in type 1 diabetes. It seems like you should continue to work closely with your endocrine and gastrointestinal team and make sure that they know that he is still not well so that other medication options can be considered.
[Editor’s comment: The only way to learn if his blood sugars are out of whack during the overnight hours is by checking your son’s blood sugars at this time. You might want to check at 2 a.m. and 4 a.m. to start and try to determine if he is having variances with which you were not familiar. The use of a Continuous Glucose Sensor could also help you learn more about his blood sugar patterns. Please be sure to discuss this with your diabetes team.