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May 10, 2008

Other Illnesses

Question from Caracas, Venezuela:

My 10-year-old son who was diagnosed with type 1 diabetes at the age of four was recently diagnosed with a neurogenic bladder. He is being treated with oxybutynin (5 mg) once a day. His A1c in the last few years have ranged from 8 to 8.9, with the most recent one 8.6. He was diagnosed at the age of eight with double diabetes and took Glucophage for a period of eight months. It helped very much the insulin resistance he had. He has never been a fat boy. At present, he is on Lantus and Humalog (carbohydrate counting). He has used NPH on two occasions, Novolin N and now we are back with Lantus. His sugar levels are checked every three hours and I wake up every night around 4 a.m. to check him and do a correction if he is high. Could this neurogenic bladder have been caused by his diabetes? How frequent is it in children with diabetes? Once you are diagnosed, can it be reversed? What should I expect in the long run?

Answer:

It is very unusual to have a neurogenic bladder caused by diabetes in a 10-year-old. I would question this diagnosis and how it was reached.

The A1c levels as you report are high and associated with all kinds of complications: eyes, heart, blood pressure and all types of neurologic problems as well as growth problems. Why are his A1c levels so high and why are they not improving? Do you need to do more blood glucose monitoring? Do you need a different type of insulin and food algorithm created?

Also, if he is not overweight, I would question the diagnosis of double diabetes. You ought to go back to your diabetes team and review how this was determined as well.

SB