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November 3, 2005

Aches and Pains

Question from New Delhi, India:

My six year old son has had type 1 diabetes for one and a half years. For the past six months, he has been complaining of stomachaches quite often, sometime mild and on a few occasions, severe. Last month, he was hospitalized for ketones (he was vomiting). His last four A1c levels were 11.0, 7.5, 7.2, and 10.5 (latest). The test for celiac disease was negative. During the stomachaches, his sugar levels range from 100 to 400 mg/dl [5.6 to 22.2 mmol/L]. It is different at different times. The time is also not fixed. Sometimes, he complains immediately after waking up in morning, sometimes while in school, and sometime after eating. His stool test was also normal. Why is he having these stomachaches? He is now taking digene for mild pain and a pain killer for severe pain.

Answer:

It’s not easy with so little information about your son’s insulin regimen, but I suspect that, because of the last, very high A1c level, the stomachache might be due to some insulin waning with sudden ketones production over the day. Also, consider that you might have even normoglycemia for some time over the insulin waning associated with subsequent ketones production. Ask your pediatrician whether this hypothesis might be of help or whether the explanation lies in another field of medicine.

MS
Additional comments from Dr. David Schwartz:

The cause of stomachaches and abdominal pain in some children with diabetes is often not elucidated. Searching for celiac disease is certainly reasonable and even if the blood tests are normal, the child may benefit from an endoscopic view of the esophagus, stomach, and first part of the intestine.

Children (with and without diabetes, but perhaps more so with diabetes) are “allowed” to have peptic ulcer-type disease. Imagine the child’s stress of having to go through all that is asked of him with diabetes.

I think, even though the glucose levels have been normal on some of the occassions with the tummy aches, that you check urine or blood for ketones during episodes of abdominal pain. Ketones can commonly cause belly aches.

DS