March 1, 2006
Complications
Question from Princeton, New Jersey, USA:
My 17 year old was diagnosed with type 1 diabetes a month ago and he is handling it better than I am. I am a registered nurse and have been devastated. My main concern is complications. When I was in nursing school back in 1978, I distinctly recall learning that diabetics begin to experience complications 25 to 30 years down the road, even if they are well-controlled. I learned that good control can only delay the onset of complications, not prevent them, because other unknown factors were believed to lead to complications, besides blood sugar levels.
I know that DCCT study showed otherwise and proved that tight control can often prevent complications. I am also reading that there are people with type 1 diabetes for over 50 years who have no complications (very encouraging).
So, with an insulin pump and tight control (A1c under 6.5%), can a type 1 diabetic still ultimately get complications? This disease wouldn’t be so bad if one could know that if you do the right thing you won’t experience the devastating complications. I cry myself to sleep every night thinking about the long-term consequences my baby might face. The pediatric endocrinologist doesn’t talk about complications…only peachy, rosy things are discussed in pediatrics.
Answer:
It’s okay for you to have a discussion just like this with your pediatrician and also with your diabetology team. The more you can get such answers specifically related to your child, the better. You are also correct that many things have improved tremendously since you were in training, with the DCCT a key harbinger of such success. Please read Type 1 Diabetes in Children, Adolescents and Young Adults by Ragnar Hanas, M.D. since it touches on many of these issues very specifically. My own professional textbook edited by myself and Viorel Serban in 2004 has much more scientific details as do many other such textbooks. You can order both from most bookstores on-line (e.g., Amazon.com) or in your neighborhood. Insulin pumps work. Multidose insulin regimens work. Frequent blood glucose monitoring and flexibility in making decisions about food, insulin, activity and illness are the keys to success coupled with a positive attitude and ongoing education and support. Please go back and discus these concerns with your diabetes team.
SB
