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March 9, 2001

Other Illnesses

Question from Australia:

I have been interested in the questions regarding abdominal pain in children with diabetes. It seems that after things such as constipation are ruled out, doctors don't have a clue. I have had some deny a link with my child's diabetes. The only real help I have had is from a naturopath. Unfortunately, your site has offered no insights other than that it is a common problem and doctors have not got the answers. It is obviously an area in which research is needed.

Answer:

The list of possibilities to explain chronic abdominal pain in kids with diabetes is a long one. First, start with a detailed and complete medical history and physical examination. This often will give some clues as to how to proceed. Lab tests including a simple blood count, chemistry panel and some other screening hormone/antibody tests may be helpful. If still no clues, then consider at least the following:

inadequate dietary fiber (fruits and vegetables) causing functional constipation
hypothyroidism
adrenal insufficiency
celiac disease
unsuspected and otherwise asymptomatic hypoglycemia
electrolyte abnormalities (especially potassium)
calcium abnormalities
lead poisoning.

Motility disorders can occur as part of diabetic neuropathy syndromes, but usually occur in older kids and with a long history of high glucose levels. If stomach does not empty properly, this is called gastroparesis diabeticorum, which can also be associated with unpredictable glucose levels since food and insulin are often mismatched. A bowel motility study may be needed to diagnose this.

Other intestinal motility disorders are even more rare, and again, would need x-ray and motility studies. Inflammatory bowel conditions may have an elevated sed rate or anemia.

Peptic ulcer disease and associated disorders do not usually present with constipation, but rather nonspecific abdominal pain. Older kids can distinguish between abdominal pains and heartburn. Sometimes, therapeutic trial with antacids will provide a clue. Endoscopy can be helpful to make diagnosis as may X-ray studies. Several acid-reducing medications also can be tried.

SB
Additional comments from Dr. Donough O’Brien:

Abdominal pain in children, especially in girls, is commonly linked to stress (Apley’s syndrome). Perhaps though, the first of many possibilities to discuss with the doctor would be getting an anti-transglutaminase test for celiac disease, which is an autoimmune-linked condition that occurs in about 8% of people with type 1A diabetes. Pancreatitis might also be worth considering, if in fact, the child in fact had type A insulin resistance with high serum triglycerides.

DOB