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October 10, 2000

Behavior

Question from Austin, Texas, USA:

How common is it for diabetes to reverse to hypoglycemia? My 10 year old has had type�1 for eight and one-half years. In the last week, her pancreas has started to function again. How can this be? Is it a miracle? She will see her endocrinologist tomorrow. We have had highs in the past. She has gone for 96 hours without an insulin injection. Her average blood sugar has been 75 mg/dl [4.2 mmol/L] but lows are in the 20s to 30s mg/dl [1.1 to 1.7 mmol/L]. Unfortunately, she has had to be injected with glucagon four times in the last few days. Are there any other known cases of this? If this does happen, is it just temporary or can it last the patient's lifetime? How could this take such wild turn after all these years? We are very excited, but nervous just the same.

Answer:

I am sorry to have to say that I think that it is very unlikely indeed that your daughter suddenly, over a few days, recovered her ability to make her own insulin. It is much more probable that, in some way, she was getting enough additional insulin to make her significantly hypoglycemic. I expect that her pediatric endocrinologist will try to confirm this by seeing if her blood has high levels of insulin, but no C-peptide. This may have been a cry for more family help in taking responsibility for her diabetes, or a reflection of some other emotional crisis. It needs to be disentangled with great sensitivity. Usually, the best person to help with this is the medical social worker or the clinical psychologist who works with the endocrinologist on the diabetes team.

DOB

[Editor’s comment: I have to agree with Dr. O’Brien. During my more than twenty years of working with kids who have diabetes, I have learned to look at situations like this with jaundiced eye. Children whose diabetes is out of control will often try just about anything to make themselves, their parents, and their healthcare team believe that they are in control. Many parents, and providers as well, have done these young people a great disservice by referring to blood sugar and HbA1c levels as good or bad, implying that the good will be rewarded and the bad punished. There can be other reasons as well for making blood sugars low, such as getting what you want to eat, getting a “buzz” when you are hypoglycemic, wanting more attention or, as Dr. O’Brien suggested, wanting less responsibility for diabetes self-management. Experience tells me any or all of things may be going on your with your daughter.

Dr O’Brien has already stated, if it does turn out that her pancreas has really not started to function again, it is essential to get professional help from a mental health specialist who understands children and diabetes. If your endocrinologist does not have such a person on staff, please ask for a referral. As your daughter begins to enter her teenage years, the problems that currently exist will only worsen if not addressed appropriately now.

I hope that my gut feeling is wrong, but if it isn’t, I hope that proper counseling will nip things in the bud.

SS]