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September 8, 2002

Complications

Question from London, United Kingdom:

My four year old child has had type 1 diabetes for two years, and I keep reading of the regular tests and checks that people with diabetes should have at diagnosis and at regular intervals. My child has regular height and weight checks along with A1c tests, but other tests are apparently not needed yet because relevant damage does not occur in young children. I'm aware of the need for good blood glucose level control, but I frighten myself with thoughts of complications and think I should be doing more to improve the A1c results (perhaps a pump, which the care team does not recommend, or different types/timings of insulin). Can you give me a perspective on this?

Answer:

See 2000 ISPAD Consensus Guidelines for the Management of Insulin-Dependent (Type 1) Diabetes (IDDM) in Childhood and Adolescence. If you go to PubMed and search for such articles using keywords, you will find articles that many of the world’s leading experts have written over the past five to ten years. Some only offer minimum monitoring guidelines since we do not really know what is optimum.

Exactly how one achieves the best possible glucose control is not one system but any system that works. This can be defined as hemoglobin A1c results, by average blood glucose results for two weeks, four weeks, etc. It must also take into account day to day glycemic variability, staying out of emergency room facilities, avoiding severe episodes of hypoglycemia, and, most importantly, avoiding DKA [diabetic ketoacidosis].

Other systems should be checked on a regular basis and include dilated eye examinations of the lens and retina, blood pressure, height and weight plotting, pubertal status for teens, injection site evaluations, assessment of limited joint mobility, thyroid assessment, assessment of lipid and kidney status and assessment of associated disorders like thyroid problems, celiac disease, celiac syndrome, Addison’s disease, etc. Some of these are clinical questions and some rely on lab or other testing.

Many of these problems take many years to develop so that very young children do not need as much intensified monitoring as in older children, teens and adults. The longer the diabetes duration, the more monitoring is needed. Some monitoring depends upon whether or not glycemic control is in a risky range or reasonable range. Several such recommendations are available on the Children with Diabetes website in articles published by some of the Diabetes Team members.

SB