May 24, 2001
Question from Missouri City, Texas, USA:
My 13 old daughter, who has had diabetes since age four, developed juvenile rheumatoid arthritis (JRA) at age nine, and we have had problems coordinating the effects of one disease with the other, particularly medication for JRA. Is there a specialty that could handle both diseases?
Type�1A (autoimmune) diabetes is quite often associated with other autoimmune disorders in the Autoimmune Polyglandular Syndrome, but although JRA is also a disorder of the immune system the two are found together rather uncommonly. Probably for this reason there is no recognised sub-discipline for their care.
In your daughter’s case, I think that the first step might be to assess how much the stress of having two chronic conditions is affecting blood glucose control. The Medical Social Worker on her diabetes team would be a good person to ask for help. Aside from that, it is essential that the respective doctors for the diabetes and the JRA communicate with each other if only to ensure that there is minimal use of drugs like methylpredisone for the arthritis.
In the end, it will be the diabetes care that has to be and can be the most flexible component. It might be a good idea for example to consider an insulin pump with its many possibilities for adapting insulin administration, and with it one of the essentially painless blood glucose devices like the FreeStyle or One Touch® Ultra.