February 22, 2004
Question from Sutton, Alaska, USA:
As a follow-up to a previous question, I would like to provide a little more information on my six year old son. We are seeing a pediatric endocrinologist out of Anchorage and she seems to be very happy with my son. He just went back in to see her this week and his A1c is back down to 8.7, which she says is very good for his age group. We have been trying to figure out what or why there are so many ups downs with him, and she told me that stress, of an unknown origin, is causing him troubles. We have discovered that, since November 2003, he has been having these episodes where his blood sugars rise unpredictably.
Through lab work, we found out that his white and red cell blood counts were fine, so there was no infection causing problems. His A1c isn’t changing much, but his BUN has risen since November. In November, it was 19, but in January, his BUN level was 24 and BUN/Creat ratio was at 46. His chloride level is a little low, and his sodium level, is 131. Furthermore, my son has also experienced bouts of high blood pressure. Finally, the school nurse and pediatrician mentioned these issues to the endocrinologist, via a phone call. The endocrinologist, who knew that I was just recently diagnosed with hypertrophic cardiomyopathy in March 2003, checked my son’s heart and found that he has a very loud and distinctive heart murmur. His blood pressure was still elevated. The veins in his neck are a lot larger than before. He’s had a history of chronic nose bleeds for unknown reasons. So, now we are being seen by a cardiologist there at Children’s. Could his diabetes have caused these heart problems, or is this something that probably was inherited from me? Do you have any advice?
Yes there is quite a bit here that, as I suggested before, cannot be optimally addressed by an informal dialogue on this forum.
I am glad that your son’s HbA1c has decreased back to less than 9% from the 12% it was before.
I know that you actually do recognize that there are multiple stresses throughout the day and some children are very adept at internalizing them. For example, he’s had the stress and excitement of the new move, new friends, new school, new weather, new parental schedules; and, given your health issues, the child can focus internally somewhat on that as well. Your child will worry about you. And, now, there are considerations that he has an illness as serious as mom’s. While not so much the “touchy-feely” sort, I’d still give strong consideration to a counselor if the glucose issues remain less optimal than you had in Texas.
Supervised hospitalization remains a tool for the “diabetes tune-up” when there are no ready answers for the patient who seems to have deteriorating glycemic control. This can help distinguish between physiologic issues and other psychosocial issues. If, in the hospital, while receiving insulin from the nurses, food trays coming at specified portions at specified times, the glucose levels are goofy, then that infers that change(s) in insulin doses, meal planning, or even activities, may be at the heart of the issue. If, on such a structured setting the glucose levels are well maintained, the implication there is “something out of balance” at home in the triad of insulin-meals-activities.
I doubt that your son’s heretofore fairly well controlled diabetes would lead to a heart issue at age 6 years, let alone hypertrophic cardiomyopathy. Infants born to mothers with poorly controlled diabetes can have a similar issue discovered at birth! There are some types of cardiac issues that do have genetic propensities. The cardiology consultant will likely shed some helpful light.