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February 9, 2005

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Question from Rockford, Illinois, USA:

My 12 year old son has had type 1 for just over four years. His endocrinologist is concerned because his growth curve has flattened out. He has always been a big boy, above 90% for weight and height. He has not gained weight or grown much in about nine months. His doctor ordered thyroid, celiac and IGF-1 lab work, plus bone age. His IGF-1 came back low (126); thyroid and celiac were okay. In the near future, he will have a provocative growth hormone test. Also, this year, he started lisinopril for microalbumin in his urine. His A1cs have ranged from 6.1 to 8.5 since diagnosis, most recently 8 to 8.3. Is there any relationship between the IGF-1 level, his glucose control, or microalbumin?

Answer:

No. Very poor diabetes control, i.e. an A1c greater than 14%, can lead to poor growth, but certainly not an A1c of 8! The ACE inhibitor doesn’t hurt growth. Children with type 1 diabetes also get growth hormone deficient. I have had it come in both directions the, growth hormone deficiency first and then the type 1 diabetes, as well as the other way around.

LD