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February 1, 2011

Complications, Genetics and Heredity

Question from Calgary, Alberta, Canada:

My 12-year-old daughter was diagnosed at 25 months. My brother was diagnosed at age 12 and recently passed away due to complications of type 1 diabetes at 48. My other brother was diagnosed with type 1 diabetes at age 42 and is experiencing some complications at age 50. His son, diagnosed at age 10 months, was having complications starting at age 15 and is now on full disability because of these complications, at age 21. Is this my daughter's fate or does she have some hope of being healthy? She seems to be quite stable 90% of the time but she has some really difficult days with highs and lows. The term brittle diabetic has been used for both my brothers and my nephew. Does heredity play a part in the stability and eventual complications or is this just luck of the draw? And, if it is heredity, can we change the outcome? I also ask this because she seems to have more problems with illnesses and she seems to have more unstable days than the other children I know who are also type 1 diabetic. Is this because she has been diabetic for so much longer than the other children?

Answer:

You ask quite excellent but complex questions. Control of glucose levels, average glucose results (and A1c levels) as well as day-to-day glucose variability and glycemic excursions (how high and how low) are all important factors. Genetics also plays a role vis-a-vis susceptibility to the complications associated with high glucose exposure over the years. Smoking, high blood pressure, weight, activity, lipids also are important factors since all these affect the same blood vessels potentially being damaged by the chronic hyperglycemia.

Frequent monitoring and close contact with the diabetes team has been proven to be important factors just as correct carbohydrate counting, timing of insulin and analysis of blood glucose results are all important for optimizing glucose control. You should be sure to ask your diabetes team these questions since they will know more specifically for any individual than general answers.

Ongoing monitoring for complications is also important since early diagnosis often can mean potential treatment. Monitoring for early protein leakage called microalbuminuria can lead to kidney protection when medications such as ACE inhibitors are used. The same can be said for early treatment of retinopathy, early treatment of hypertension, early treatment of low vitamin D levels and early treatment of lipid abnormalities, thyroid problems, celiac disease, etc.

Please go back and review this with your diabetes team so that they can provide more details. We learned from many studies such as the DCCT and EDIC that glucose control is still a key factor and that targeted achievement of glycemia with MDI or pump treatment seems to be the optimal approach coupled with close and frequent contact with the diabetes team, family, home analysis and frequent blood glucose monitoring.

SB