July 1, 2003
Daily Care
Question from Scranton, Pennsylvania, USA:
My son has had problems with his sugar readings no matter how hard we have tried, and his hemoglobin A1cs are 7-8%. He did a glucose monitor for 48 hours about a year ago which showed he has dawn phenomenon so we changed insulins. He is starting the insulin pump today, and I pray that this helps. I am so worried about him.
He was complaining of stomachaches, so we took him to a pediatric gastroenterologist who found he had showed a fatty liver. Followup is in a month. He has been having ingrown toe nails so has been seeing a podiatrist who is taking good care of that problem.
About a month ago, he started complaining of chest pain. I took him to our family doctor who ordered an echocardiogram and a stress EKG which look good except that his resting blood pressure was 160/84. After three minutes on the treadmill, his heart rate reached 194 with a blood pressure of 178/80 during resting period. Immediately after the stress test, it was 204/94 with a heart rate of 142, then it remained elevated. He complained of chest pain as soon as the stress test was over, but not during it.
My son’s doctor says everything is okay, but she allowed him to see a pediatric cardiologist. The end results of tests say everything’s fine except for mild resting pulmonary hypertension which they have listed as no stenosis, trivial insufficiency. What is that? What should I be asking the cardiologist?
Answer:
What you describe is most unusual for a child or teenager with type 1 diabetes. You did not describe whether or not your son is significantly overweight since fatty liver would be more common associated with obesity or being overweight and also associated with very high hemoglobin A1c levels (more than 10-12%, not 7-8%).
It is common to have difficulty controlling blood glucose levels in the prepubertal and puberal years because of growth hormone and sex steroids being produced, associated with known insulin resistance, etc. Insulin pump treatment should be helpful.
There are several other potential problems that can be ruled out with appropriate lab testing. Has your son been checked for thyroid disease (T4, TSH and thyroid antibodies)? Addison’s disease (adrenal antibodies) and fasting morning cortisol levels? celiac disease (transglutaminase antibodies)? Is there any lipid abnormality or kidney abnormality? Since sometimes these illnesses masquerade as odd and nonspecific symptoms. Lastly, is there any component of anxiety that may contribute to such chest discomfort? A good psychologist knowledgeable about diabetes as well as adolescence and childhood issues should help to sort this out as well.
I hope that you are working closely with a pediatric diabetology team to try to sort this all out. They should also have good input regarding the findings of the cardiologists since they do not make much sense.
SB
