My five-year-old son was diagnosed with type 1 nine months ago, just before his 5th birthday. He had lost weight before diagnosis, so we were glad to see him get back to a healthy weight after treatment began. But, now he’s in the 88th percentile for BMI for his age, technically overweight, though it is not obvious from looking at him. His eating habits have changed a lot since diagnosis, mostly because his doctor required more snacking than we used to do and because of the treatment of lows. Our diet is still balanced and healthy, but I worry about the long-term impacts of weight gain. Am I worrying needlessly?

You are not worrying needlessly.

The Diabetes Control and Complications Trial (DCCT) from the 1990s showed that “tighter” glycemic control decreases risks of diabetes-related complications (such as kidney, neurologic, and retinal/visual issues) in patients (primarily adults but also some teens). Even patients who already had such complications had a slowing in rate of progression when under more intensive glycemic control. We strive for “tighter” control now. However, the DCCT also showed that intensive control increased risk of serious hypoglycemia and was associated with weight gain.

As you have learned, glucose control hinges on insulin, food intake, and exercise. These variables are pretty equal in their effect. But, exercise tends to be overlooked by some. The easiest way to address high glucose is by giving more insulin. Maybe food and adjustments and/or increasing exercise would actually be better. People do not like the concept of “limiting food.” I don’t know if you can make a five-year-old any more active, but I would encourage activity.

You did not mention the specific insulin regimen that the child is following and that may be very pertinent. If your son is on a “basal-bolus” insulin plan, using a long-acting insulin [e.g., insulin detemir (Levemir) or insulin glargine (Lantus)] plus a rapid-acting insulin [e.g., insulin aspart (NovoLog), insulin lispro (Humalog), or insulin glulisine (Apidra)], then frequent snacking may NOT be required. But, if on an insulin plan using an intermediate-acting insulin [e.g., NPH], then snacking might be required.

Is your child growing taller? Has there been screening for concurrent thyroid disease? These are important questions, too.

Long term issues with excess weight bring the possibilities of concurrent insulin resistance (even in patient with type 1 diabetes), lipid metabolism issues, heart disease, liver disease, bone disease, and others, depending on the degree of overall weight. What is the child’s body mass index (BMI)?

Please bring up your concerns with your diabetes team.

DS