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October 24, 2003

Daily Care

Question from Tallahassee, Florida, USA:

I understand that weight loss and diet are important factors in maintaining good sugar control, but my child has never had these problems. She has always been within the correct parameters for her height/weight, and her diet has always been healthy (prefers salads and fruits to candy) so it was with extreme shock that I was told she had diabetes and was close to coma stage when she was diagnosed with a glucose level of almost 1, 000 mg/dl [56.7 mmol/L] That's right -- I'm not kidding. The child was walking around like there was nothing wrong with her -- no signs indicative of a problem. The discovery was accidental. The lab tech ran the wrong tests and then re-ran them three times to make sure he was looking at a live human. That was 10 years ago, and now I find that she's become insulin resistant. I can find no real research to tell me what to expect and her doctors are not really sure what we can expect other than increased insulin. Already, she shows signs of extreme exhaustion, nausea, stomach upsets, and other irritating, but non-specific, symptoms of a child with a minor cold, but they never last long enough to get a handle on. She also has active lupus, arthritis, bilateral cataracts with implants, active von Willebrand's disease, and her immune system consistently shows high levels of antibodies present with no infection to justify the levels. Where can I find information on insulin resistance and its effects on the body? What can I expect to see happen? Her kidneys are already damaged. Will they get worse? What do I do?

Answer:

I think there are several features here that need to be clarified. It sounds as if your understanding that her diet and activity “caused” her diabetes. That is not true. Diet and activity play important roles in regulating glucose levels, but the “cause” of diabetes has multiple influences. For example, the most common cause of type 1 diabetes is typically a process in which the body’s own immune system produces antibodies that “attack” the insulin production capacity of the pancreas. In a girl whom you describe as having lupus, and arthritis (JRA or similar), then I think one has to be concerned about an autoimmune pancreatic issue also.

However, if she is on steroids (like prednisone), this can also lead to higher glucose levels and more of a type 2 diabetes picture in which whereby the body is rather resistant to the effects of insulin. Large doses of steroids can lead to cataract formation so I wonder about that in your daughter.

You ask great questions that really cannot be addressed completely in this forum. You can search this website for some information, but your best source will be your pediatric endocrinology diabetes team and their Certified Diabetes Educators. If you have not already had a referral to such a (or even if you have), ask for another one to get your questions answered.

DS