My 11-year-old daughter has had type 1 diabetes since October 2004. She is using Mixtard 30 Penfill by Novo Nordisk manufactured in China and packed here in Pakistan. She is taking three shots a day, 16, 8, and 14 units, prescribed by our general physician. Currently 137 cm tall (about 4 feet, 5 inches) and weighing 64 pounds, my daughter seems smaller than most of her classmates, friends, and siblings. She eats a lot but her weight and height are not improving according to the pediatric growth chart. In March 2009, she was 121 cm (just under 4 feet) tall and weighed 48.5 pounds. Is there some reason she is not growing?

Growth is multifaceted. Important genetic influences, as well has environmental, nutritional, hormonal, and other important health issues factor in to how tall we are getting and how tall we are supposed to be. Weight is influenced similarly.

You did not indicate how tall you and your daughter’s other parent are. Furthermore, while your daughter may have been born in the United States, if her primary ethnic heritage is Pakistani (or other nationality), then more encompassing genetics may also play a role. I do not have easy access to Pakistani pediatric growth charts. Using the information that you provided, I plotted out her heights and weights on the U.S. Centers for Disease Control (CDC) growth charts: at age approximately 9 years, 2 months, your daughter’s height and weight plotted just below the 3% in height and just above that in weight; at about age 11 years, 4 months (“about 5 months ago”), her height had increased and plotted just below the 10% and her weight then just below the 3% on the CDC growth charts. The recent measurements that you gave, suggests she is about age 11 years, 8 months, and she continues to plot just below the 10% in height but her weight has caught up to slightly above the 3% again. We must recognize that these are all approximates given lack of specific dates, etc.

Poor weight gain is common in poorly controlled type 1 diabetes; weight gain is common in well-controlled type 1 diabetes and, in fact, there can be excessive weight gain if the diabetes is not controlled, in part, by exercise, in addition to insulin. Height tends to fall off only in type 1 diabetes when the control is really, really, poor. In such cases, there can be delayed puberty and even enlargement to the liver.

Again, knowing how tall your daughter’s parents are can assist in knowing if her growth potential is “on target”. Otherwise, if you have deeper questions about her growth, development, and health related to her diabetes, it would be best if she is seen by her primary pediatric-focused healthcare giver.

DS