September 9, 2002
Other Illnesses
Question from Guelph, Ontario, Canada:
I was intrigued with the response to the posting regarding a three year old child’s diagnosis of both type 1 and childhood nephrotic syndrome. My nine year old child has both conditions, and every doctor I have asked says the same thing — “I have never heard of a child with both conditions”.
My nine year old was diagnosed with diabetes at age three, five months later he was diagnosed with minimal change nephrotic syndrome, and he has had many relapses since. Since then, I have heard of another three year old in Canada who was diagnosed with both conditions five months apart. I also found two references on the Internet to preschoolers with both conditions diagnosed a few months apart.
What is the statistical chance of a child getting both diabetes and childhood nephrotic syndrome? Since three of the five I have heard about were diagnosed at age three, what could be the link? Is three years of age a critical stage in immune system maturity?
I will also mention that the treatment for nephrotic syndrome is usually prednisone, which causes high blood sugar — a double whammy for a person with diabetes. We usually have to double my son’s insulin with 48 hours of beginning a course of prednisone.
Answer:
I suspect that you are correct. These are merely bad coincidences of two miserable conditions. You are also correct that when using steroid medications for correct medical reasons, you will need massive increase in insulin dosage when the prednisone effect starts (about six to eight hours after the first dose) and until this effect is finished (about a day or so after the last dose). You can figure this out with close contact with your diabetes and kidney consultants talking to each other and, most importantly, with frequent glucose monitoring.
SB
