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June 22, 2008

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Question from United States:

I have two children with type 1. My 10-year-old daughter was diagnosed four years ago and has been using an insulin pump for three years with an A1c consistently between 6.8 to 7.1%. My 16-year-old son, who was diagnosed almost two years ago, prefers injections (Humalog/Lantus) and has never had an A1c above 5.7 and does not need to be nearly as regimented as his sister does with his care, and yet, his numbers remain excellent. We have been told he is not honeymooning almost two years later, as he can take up to twenty units of Humalog to cover a single meal. He never has any significant lows, always wakes up in normal ranges, doesn't count carbohydrates, and has a much easier time than his sister who has to work twice as hard. We have been told by his endocrinologist that this is because he's tall, thin and a runner. I understand this, of course, but his sister, by comparison, eats healthier, is a healthy weight and, although not as athletic as her brother, exercises several times per week. Having two children in the house with the same disease is difficult enough, and, as much as we try to tell our daughter that she should not compare herself to her brother, she wants to know why it is easier for him. Any thoughts other than what we already know or have been told?

Answer:

I can only echo what your endocrinologist has relayed. The importance of exercise cannot be underestimated. Your 10-year old daughter, who is a “healthy weight” and not as athletic, is probably not as insulin sensitive as her athletic, thin brother. Furthermore, any state of hormonal “fluxes” as she begins and progresses through puberty may be playing a role as well.

I would add that I would not exclude the possibility of a prolonged honeymoon in your son, giving him a false sense of security allowing him to “eat as he pleases.”

One last thought, just to be more complete: how was the diagnosis of diabetes made in your son two years ago?

DS