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May 24, 2001

Daily Care

Question from Gallupville, New York, USA:

My one year old niece was just diagnosed with type 1 diabetes, and she also has Down's Syndrome. Is there anything different we should be looking for in monitoring and controlling her diabetes? Is there a quicker progression of the disease?

Answer:

I am not aware of any “quicker progression” of type�1 diabetes in young people with Down’s Syndrome, but there certainly will be other caveats. Such individuals tend to be heavier, and this stresses further the importance of exercise, not only for weight and general good health, but for better diabetes control.

“Tight” glucose control can lead to weight gain in anyone with type 1 diabetes so exercise, with attention to meal planning, cannot be ignored. Extra attention may need to be spent with the accessibility of “snacks” or other foods not on the meal plan.

Depending on your niece’s developmental skills, there may be limitations in her abilities to participate in her diabetes self-care. However, I would encourage the family to find some aspect of her diabetes care with which she can play an active role. That might include picking the site for a glucose test, or picking the site of an injection. She may be help to “help” by pressing the plunger on the syringe. I would be cautious about leaving insulin and syringes easily accessible and unsupervised. She certainly should wear some type of Medic-Alert -type identification.

Individuals with Down Syndrome are at increased risk of other types of autoimmune-related diseases in addition to type 1 diabetes, including thyroid problems, arthritis, and others. Your niece’s diabetes team and general pediatrician will want to screen for these things periodically.

While managing a child with special needs can be a challenge, and while the extra burden of type 1 diabetes may seem hard, it has been my clinical experience that many Down’s syndrome children with diabetes are still very pleasant and loving and generally easy to care for.

DS