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November 13, 2007


Question from Singapore:

My almost 13-year-old daughter has had type 1 diabetes for three years. She is on Lantus (28 units) and NovoRapid (12 units for breakfast, eight for lunch, and eight for dinner). Her A1c is 6.5 and always between 6.5 to 7.1. She has started her periods this week. Her height is 152.3 cm (almost 5 feet) and weight is 44 kg (97 pounds). All her friends are taller than she is. She has not yet had a growth spurt. This year she has gained 5.3 cm (2 inches). The doctor has done a bone age x-ray and it shows 13 years, which he feels is okay. All other tests, including a growth hormone test, are also within proper limits. I am 164 cm (5 feet, 5 inches) and my husband is 167 cm (5 feet, 7 inches). Will our daughter grow after her periods or not? Her doctor says it varies from child to child. I have started her on multivitamins also. Her T4 free serum was 13.2 and her TSH serum was 1.797, according to tests in January. Her doctor is giving her thyroxine, 50 mcg, at night. What are her chances of growing taller? Do you think she is on the right track growth wise?


I am puzzled by your thyroid results and the need for thyroid hormone unless they are in some other units with which I am unfamiliar. It sounds rather healthy and with great A1c results, it is so unlikely that her diabetes is related to her current growth issues. It also sounds like all other endocrine tests have been explored. We would also usually check for celiac disease, although this may be less common in a non-Caucasian adolescent. I would continue to work closely with your diabetes team and watch her growth charts as well as physical exam since this will also tell you a lot about current and future growth. With bone age checked and not delayed or advanced, she still has about 4 or 5% more growth potential remaining.