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November 30, 2003

Puberty

Question from Houston, Texas, USA:

My son turned 14 in August and had grown only 3/4 of an inch in almost 2 years. His dad is 6'3" and I am 5'10". All male family members are over 6 feet and all females are over 5'8". His growth pattern since birth had been at 95%+ in height and 75% for weight. His current height was 61 inches and weight was 112 pounds. We took him to a pediatric endocrinologist and blood work was done. IGFBP-3 = 3.6, T-4 FREE=1.1, TSH =.62L and IGF1 = 192L. Bone age x-rays revealed he was at 12.5 years. The doctor said he was in early stage 2 puberty during his checkup. One month later he went into DKA with a 711 mg/dl [39.5 mmol/l] blood glucose reading and was diagnosed with type 1 diabetes. We have no family history of diabetes. I have two questions. First, given the high levels at the time he was diagnosed, shouldn't his glucose have been elevated when the short stature evaluation was preformed a month earlier? Would the above tests have included a glucose reading? It is my understanding that his elevated levels probably had been going on for quite some time. Is there a way to determine how long? Second, how much, if any, could this have been affecting his growth? Do you see increased growth rates once teens have controlled glucose levels?

Answer:

It is really impossible to know when the actual blood glucose rise took place. A random value at the time of the growth evaluation may or may not have been elevated. Also, a glucose reading is not a usual part of such evaluation since they are very specific for growth and pubertal hormones, for instance. Growth just prior to diabetes onset is usually normal except for weight. If any change from normal pattern, youngsters with diabetes have a slight tendency to be taller than their peers but not in any major fashion. High sugars for many years clearly have a deleterious effect on growth and puberty but short periods of time, even several weeks, are generally not going to show up as any growth or pubertal deviation under most circumstances.

SB