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September 10, 2001

Daily Care

Question from Fayetteville, North Carolina, USA:

My 22 month old twin girls have both recently been diagnosed with type 1 diabetes, and at our last visit to their pediatric endocrinologist, both of them were taking Lente and Humalog at breakfast with a sliding scale of Humalog at supper. Their logbooks showed that they were both low before breakfast and elevated the rest of the day. The doctor did not explain what he was looking for and did not ask us if there were any symptoms other than the low reading in the morning when no insulin was in their bodies, and ordered a long list of blood tests. Another doctor consulted with us that day. He was only asked to look at the feet of one of the girls, but he also looked at the log books and told us that perhaps the Lente was peaking after 22 hours rather than 10 hours, and suggested we change to NPH. That has solved the problem. -- The morning blood glucose has been just right! I have just received the results of those tests which all came back normal, except that one of the girls may have the potential for celiac disease. On the report I received is a statement indicating that some of these tests are not approved or cleared by the FDA. That is alarming to me. Also, the woman who took the blood was surprised by the doctor's orders to do all of these tests. I'm just wondering if it was necessary to subject my children to all of that blood work. Shouldn't he at least have asked me about other symptoms before considering the possibility that there were other diseases or complications? Should I get a second opinion or perhaps a new doctor?

Answer:

I don’t think you need a second opinion, as I can guess what I think your doctor was looking for, although I am also a little surprised that he didn’t simply first adjust the insulin rather than perform a variety of tests. Usually, our bodies produce a variety of hormones in the early morning hours that lead to an increase in the morning, fasting blood glucose. Some of those hormones include cortisol and growth hormone. The observation that your daughter’s weren’t experiencing higher glucoses, and in fact had lower morning glucoses probably wanted him to look for the morning surge in either or both of these hormones. For example, the adrenal glands where cortisol is made, can be subject to the same immune system inflammation that caused the type�1 diabetes (an autoimmune process) leading to decreased cortisol and therefore lower blood glucoses.

Since there already was evidence of immune-related problems, there is an increased chance for other autoimmune problems and that was probably what he was looking for. The statement that the test is not “FDA approved” mostly means that it is not commercially done, but does not at all mean that the test was done in some underhanded way.

I think that you should discuss the fact that you indeed wish to be more involved and informed as to the various tests and procedures that your children will undergo with their doctor. He or she will probably welcome that. If not, it certainly is your prerogative to find a caregiver with whom you are comfortable. I am glad that the simple change to NPH worked for your twins.

DS