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February 1, 2003


Question from Santa Barbara, California, USA:

My 13.5 year old son, diagnosed with type 1 diabetes three and a half years ago, has been on an insulin pump for the last six months, and he is very responsible, compliant, and self-reliant about his diabetes, and his A1c is always 6% or lower. He is in eighth grade, and despite his age, his bone age on x-ray was 10 years. All blood work was done and he does not have any thyroid deficiency. He was tested for celiac disease, but he does not have it. He is growing about at least one-half inch every three months, but according to his endocrinologist, my son shows no signs of entering puberty. On his dad’s side of the family, at least six males have told us that they did not start growing (enter puberty) until the age of 16-17. We were given three choices:

Do nothing and wait.
Eight shots of testosterone, one every three weeks.
A protocol to test for growth hormone deficiency involving taking one shot of testosterone and then doing blood work a week later.

I don’t usually have trouble deciding things, but I am really ambivalent about what to do. Psychologically, being so short and having diabetes and entering high school looking like he is ten years old will be very hard on my son. In addition, he is going from a small private school that he has attended since kindergarten to a large, urban high school. Yet, I wonder if the shots will really interfere with his blood glucose control so much, that we should just wait and let him grow when it is his time to grow.

What to do? How to think about the problem constructively? We have a wonderful diabetes team who will allow us to make the decision, but I wanted to get a second opinion.


From: DTeam Staff

From your description, this sounds like delayed puberty on a familial basis and unrelated to his having diabetes. So, the options you have been given are the correct ones. A key element is asking your son what is his preference since treatment for benign, delayed puberty is often mainly a psychosocial issue and not a strictly medical one. You should go back and review this with the endocrinologist providing you such good advice and then decide together how to proceed.