I am a mother of an 11 year old boy who has had type 1 since the age of 3. He also has been brittle all along. He developed acute pancreatitis last year and was on TPN [total parenteral nutrition, using an intravenous tube for supplying all nutritional requirements] for almost 4 months. It’s been 1 and 1/2 years and he still is in and out of DKA. A lot of the professional people that work with us suggest going to the pump to try and keep him under better control, though because of age his endocrinologist wants to wait a year. I’m really concerned because of all the medical factors involved with his ups and downs. Any suggestions would be great. Oh, they are also looking into him being insulin resistant.

The term ‘brittle’ diabetes has nowadays lost favour as implying some special type of diabetes and is used more as a euphemism for poor control. So it would be important to discuss with the doctor exactly what he/she thinks are the main reasons for this.

In this connection, one possible explanation is that your son might have what is called ‘Insulin Resistant Diabetes Type A’. Clinically this is very like the common autoimmune form of diabetes in childhood; but amongst other differences the antibody test (which might not have been done when your son first developed diabetes) is negative and the condition is often accompanied by high fat levels in the blood (hypertriglyceridemia) and also by additional skin pigmentation on the neck and in the flexures called acanthosis nigricans. It is commoner in females; but hypertriglyceridemia can also occur in males. This high serum fat levels can cause pancreatitis and of course the stress of this can interfere with good control.

Another less likely possibility for poor control and gastrointestinal symptoms might be that your son has another autoimmune condition called celiac disease, which occurs in up to 10% of diabetics and which can be diagnosed by doing a test for serum anti-transglutaminase.

A few tears ago pumps were not recommended for children in poor control; but this need not apply to your son if the specific cause of this poor control is better understood. Another factor that has to be considered is that although many children have been started on pumps before the age of eleven, not every physician has the experience and nursing help that is needed for early instruction and pump monitoring.

DOB