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August 26, 2000

Behavior, Complications

Question from California, USA:

My 14 year old daughter was diagnosed with type 1 diabetes two and a half years ago. Her levels have never been in good control. They run between 300-600 mg/dl [16.7-33.3 mmol/L] consistently including several times a day. She takes over 200 units of insulin daily. She complains of being severely fatigued. Her thyroid checks out normal. An antidepressant did nothing to make things better. She is so tired most days that, even though she pushes herself to go to school and make it through a whole day, she can't and is missing a lot of school. In addition to the fatigue, she complains of very painful stomach aches which seem to be getting worse. An ultrasound ruled out gallbladder disease. I know high blood sugars can cause fatigue but it seems no matter what she does she can't get her blood sugars to stay down for more than maybe one day at the most. Could the fatigue, stomach pain and high blood sugars be related so something other than her diabetes even though her pediatrician says it's probably not? I am very concerned for her future. She is quite frustrated and is asking for help to feel better, but we don't know what else to do.

Answer:

The fact is that many adolescents are like your daughter. Nowadays there is a fair bit of evidence that many such patients don’t take all the insulin they are prescribed so I would start with this supposition. After that you are into the realms of other physical or psychological problems and you will no doubt have discussed these with your daughter’s team.

KJR
Additional comments from Dr. Bill Quick:

It’s not clear from your question whether your daughter is under the care of a diabetes team that is experienced in dealing with teenagers. If not, insist upon a referral!

WWQ