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May 29, 2002

Complications

Question from Lansing, Michigan, USA:

My 15 year old son has had type 1 diabetes since the age of 10. His growth pattern since diagnosis has been in the lower percentile range, and for the past few years, he is almost at the bottom of the range. His height is now at 5 feet 2 inches, and he weighs about 105 pounds. The doctors did a growth test on his bones and the results indicated that he was on track. However, my concern is that his growth has been inhibited by something related to the diabetes. I recently read an article about people with diabetes producing too much cortisol. According to the article, cortisol is a catabolic hormone which breaks things down as opposed to anabolic which stimulates growth. The suggestion is to increase the protein levels by considering whey protein. Is this the suspected reason why some people with type 1 diabetes may have inhibited growth? Is there any significance to the article and its conclusions?

Answer:

I am assuming that at the time of diagnosis your son was of average height and weight or perhaps a little below that for his age and that over the last five years his rate of growth has gradually fallen to the present position on the 3% level on the growth chart for boys in North America. I think there are several possible explanations for this, but by far the most likely is that he if fact has what is now called the Autoimmune Polyglandular Syndrome Type II, a condition in which a number of autoimmune disorders are grouped together. By far the most common one to be linked with type 1A (autoimmune) diabetes is hypothyroidism, and if it has not already been done, you should ask his doctor about getting a blood TSH level. Another relatively common association (about 8%) is with the celiac syndrome, which can be tested for with a blood antitransglutaminase test. This can be symptom-free and still be the cause of poor growth. There are of course unrelated possibilities such as poor blood sugar control and perhaps even an overly restricted diet.

I looked at the website you mentioned and felt that the argument in respect of cortisol was ill-sustained and certainly not a justification for increased dietary protein. Moreover, the site appeared to be linked to another which in my opinion contravened FDA regulations in that it made specific claims for an unapproved dietary supplement which other studies have not confirmed.

Protein requirements for a 15 year old boy are 0.9 grams/kilogram/day, and in the US, most children get much more than this. At the next visit it would be important to talk all this over with your son’s doctor.

DOB