October 31, 2002
Question from New Zealand:
My 10 year old daughter, diagnosed with type 1 diabetes at age seven, has reasonably good control, but she experienced an injury to her foot some 10 months ago and has developed RSD (Reflex Sympathetic Dystrophy). At this stage, it is limited to her lower leg and foot causing fairly severe pain at time, often very purple colouration with bright red areas, swelling and often very cold which is now spreading up the limb toward her knee. Treatment so far has included being in a plaster cast and medications for pain. She has been unable to put weight on her foot some about three months now, and her glucose levels are a little high due to the lack of exercise. She is also quite sensitive to insulin and even an increase of half a unit can send her into hypoglycemia quite easily. I am a little concerned about long term effects on her foot. How concerned should I be about this? Can we expect any long term complications?
I have no personal experience with what you are describing in a child. Most children do not have diabetes of sufficient duration to have major damage to blood vessels or nervous system so it is not clear that this is related at all to her having diabetes. Particularly if her hemoglobin A1c levels are less than 8%, this would be quite rare to be related to her having diabetes. I would suggest you work closely with her health care team and make sure that specialists in neurologic, orthopedic and vascular problems are consulted in addition to her diabetes team.