April 2, 2000
Question from Illinois, USA:
My niece is 13 years old and she has type 2 diabetes. They told her only 7% of her gallbladder is working and should come out. Now they has been doing test after test and they say she has gastroparesis. They started her on some medicine but doesn’t help. The medicine is supposed to be for the gastroparesis. In the mean time her gallbladder is still there. Shouldn’t they be worrying about getting the gall bladder out and then work on the gastroparesis? Her parents are divorcing and her father says to her that he can’t afford these doctor bills. She is so stressed out and she is constantly crying or whining about not feeling good. What can I do for her?
From a distance I think that there are two aspects of your niece’s story that might be further explored. First of all the father’s concern over money suggests that the family may have no health insurance and yet have an income that exceeds the limits for Medicaid eligibility. All states however do have additional funds to help with health care costs for children that are in this group although of course there is an upper cut off limit. If this might apply it would be worth enquiring about such assistance in either the State Health Department or the Office of Social Services.
The second point is that gastroparesis is exceedingly rare in a 13 year old girl even if she has been in poor control for many years and likewise cholecystitis (gall bladder inflammation} is also uncommon. I don’t doubt that she has gastrointestinal symptoms; but before considering surgery I would think it a good idea to explore the possibility that these symptoms have a psychosocial basis and also the possibility that like up to 10% of Type 1A autoimmune diabetics she might also have celiac disease, a wheat protein sensitivity of the upper bowel mucosa. Her parents might talk to her doctor about a serum anti transglutaminase or anti glutamyl transferase test to explore this possibility. In addition it might be worth considering a second opinion from a diabetes team, such as would be found at a Children’s Hospital. Such a team would almost certainly be working with an experienced Medical Social Worker who could help greatly to disentangle your niece’s feeling about her diabetes.