My 11 year old daughter, who has had type1 diabetes for two years had fine control in her first year, but, this second year has been terrible with amazing swings from highs (31mmol/L [55.8 mg/dl] ) to lows(1.9 mmol/L [34 mg/dl]). At Christmas, the doctors discovered that her pancreas was actually producing its own insulin, but sporadically and not in sufficient quantities to come off it for very long (she has had two episodes completely off insulin, one for 10 days and one for two days). During the last episode (about two weeks ago) she was having hypos on no insulin which the doctors couldn’t understand. Has anybody ever come across this type of problem? If so, has any particular regimen helped? The doctors have ruled out an insulinoma and pituitary problems.

It is always a little difficult to offer help with such a complicated story. I assume though from the sophistication of the investigations that your daughter is being looked after by a paediatric endocrinologist and that the commonplace explanations like dietary variations, strenuous exercise and Somogyi Effect have been ruled out.

One possibility is that your daughter has type 1B diabetes, that is idiopathic rather than autoimmune diabetes. This is uncommon in Caucasian families, but would be a possibility if she had a negative antibody test at the onset of her diabetes. About 50% of these children are able to do without insulin after a variable number of months. It is just possible that these widely varying blood sugars represent a delay in what is called ‘first phase insulin release’ in the recovering beta cells. This would lead to a pattern of inappropriately high blood sugars after meals and correspondingly low ones later.

An alternative explanation of these widely and inexplicably fluctuating blood sugar levels and one that needs to be taken seriously is that they are artifactual. It is easy for an 11 year old to fudge blood sugars, and this may well represent a plea for help which she cannot verbalise. The problem may be that she feels unduly burdened with the responsibility for her diabetes management and that she is not getting enough family support or she may be depressed and unduly concerned about the effect of diabetes on her life.It might even be something quite simple such as resentment at all the finger sticks, a problem that could be solved with one of the new meters that use a tiny amount of blood from the forearm and are essentially painless like the FreeStyle or One Touch� Ultra. This is in fact a rather common problem especially in girls in the teen and pre-ten years and needs to be investigated with great sensitivity. You could get some confirmation of this if you took over all the details of injections and blood sugar monitoring for a short while under the guise of ‘giving her a rest’. However, I think you are going to need help and very often the best person to disentangle this sort of an issue is the medical social worker in the clinic.

DOB