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January 26, 2003

Complications

Question from Palo Alto, California, USA:

My seven-plus year old daughter has had diabetes for a bit more than seven years, I have been hearing that even young children can show signs/symptoms of serious complications which I was very surprised to hear. Is this true?

Answer:

I hope that my response reassures you. Your daughter’s own diabetes team has heard these questions before so you should feel comfortable asking them.

There are growing data that subtleties of glucose control may certainly influence overall risks of complications. These data are from adults. Mostly the concerns are on what is sometimes referred to as “glucose excursions” i.e. the degree of glucose elevation after meals. So, in adults, the understandable inference, and therefore clinical push, is for tighter and tighter control. However, the available data do not seem irrefutably conclusive. There are not so much data on these issues in children. While good control is the goal, children may have more risk of complications of hypoglycemia so that is the trade. So target glucoses (before and/or after meals) and hemoglobin A1c results need to be set by your own diabetes team for your individual child.

In broad terms, one would not expect complications of diabetes, such as kidney or eye disease, to occur until more than four to five years into the diagnosis and really only then if someone has had really poor control. If your daughter was diagnosed at age five, one might assume that she entered her honeymoon of diabetes (with the concurrent good control) shortly after she was diagnosed. The honeymoon lasts about a year or so. So even if she were in poor control, it hasn’t been for a long time! You are wise to be looking ahead and integrate those good habits now.

DS