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April 8, 2003

Daily Care

Question from Jacksonville, Texas, USA:

My six year old daughter, diagnosed with type 1 diabetes and celiac disease, is not on any medication for the diabetes, and they say she is in the honeymoon phase. Lately, however, her sugars are beginning to come up (as high as 585 mg/dl [32.5 mmol/L]), but she still sometimes has hypoglycemia in the morning. Her pediatrician thinks she would benefit from the pump so the insulin can be given in small doses and is concerned that her endocrinologist hasn't decided to place my daughter any type of regimen. I tend to agree with her pediatrician, even though she has the hypoglycemic episodes. The high sugars should not need to be ignored. She is only seeing the endocrinologist every six months, and I would like to have a second opinion because I worry about the long-term effects this will have on her.

Answer:

I would agree that the diabetes needs attention, but I am also concerned that she gets hypos with no treatment. I would also ask about the celiac disease (treatment, etc.). Is there a GI doc [gastroenterologist] in the picture?

Insulin pumps in a six year old are no picnic, and though I have some, it involves a lot of investment by the parents. Certainly hypos on no insulin make me nervous too regarding insulin treatment. It will likely mean some meaningful dietary therapy. Is she a picky eater? That would make it even harder. I would like to be sure of frequent calories to keep the glucose stable.

LD