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June 29, 2002

Other Illnesses

Question from Clemson, South Carolina, USA:

My eight year old daughter, diagnosed with type 1 diabetes at age three and a half and using an insulin pump since age five, swims year round with a swim team and also every day for fun during the summer. She has suffered from otitis externa infections for about nine months now, with itching, pain, discharge, and some hearing loss. After treating with a variety of prescription ear drops and oral antibiotics, a culture revealed that she has an aspergillus fungus infection in both ears. Anti-fungal drops and using alcohol-vinegar combination ear drops after swimming or bathing helped, but a month ago, she developed a fever and ear pain that we treated with the same anti-fungal drops and an antibiotic (just in case it was a sinus-related infection). A week after completing the medications (a week of swimming in the ocean, eating late dinners, and having sustained high blood glucose levels overnight), she developed sudden ear pain, discharge, and high fever with moderate ketones. We're trying a newer anti-fungal ear drop, ibuprofen for pain and fever, and keeping her out of the pool, while waiting for a referral to an ENT. We're trying to keep the blood sugars down, but they are hard to control when she's fighting an infection. Is there anything else we can do to treat/prevent this problem? Giving up swimming would break our hearts. Is she in danger of hearing loss or worse from these chronic infections? Is her blood sugar the culprit in this situation?

Answer:

You did not really say how well controlled she is. If she is in poor control with a hemoglobin A1c greater than 8%, this could lead to sustained infections, especially with a fungus! The ear infection, per se, is not going to cause diabetes issues, other than higher sugars in the short-term as you have already seen with fever and stress, etc.

Maybe I missed something, but I don’t understand how she was allowed to keep swimming with chronic external otitis? I presume you try to optimize things and have her wear ear plugs, etc. Chronic ear infections are certainly a risk for hearing loss. I applaud that you will have her seen by the ENT.

DS