My three year old son has just diagnosed with diabetes and is in the hospital now. His blood glucose was 27 mmol/L [486 mg/dl]. The doctors give him 2 or 3 injections every day, and now his blood sugars are 7 to 8 mmol/L [126 to 144 mg/dl], but sometimes it goes to 2 or 3 mmol/L [36 to 54 mg/dl].

Is there any treatment besides insulin? Is there any treatment to finish the diabetes forever? I have heard there is an inhaler. What do you think about that?

At the moment it doesn’t sound as though your son is in very good control of his blood sugar; but I am sure that the diabetes team are working hard on this and that he will soon be stabilised. For the time being, and assuming that he has type�1A (autoimmune) diabetes, which is much the most common form in his age group in Europe, he will need to have some form of supplementary insulin for the rest of his life, but there is a real possibility that improvements in islet cell transplants and in genetic engineering may one day make injections unnecessary. In the meantime, insulin can be given effectively by inhalation, but the apparatus is far too cumbersome for a three year old. A more promising system , just undergoing clinical trials in children, is one in which the insulin is delivered from a small cylinder about the size of an asthma inhaler. With this device, the insulin is actually absorbed from the mucosa of the mouth.

You might also want to think about one of the almost painless devices for doing blood sugars. These use a tiny drop of blood from the forearm. Your son’s doctor may want to suggest a special one; but in the meantime look at the FreeStyle and the One Touch� Ultra meters.

DOB

[Editor’s comment: As of this writing (February, 2001), insulin inhalers are very promising, but have not yet undergone full scrutiny by the FDA, and hence are only available in clinical trials (in the USA). I am unaware of them being available for general use in any part of the world at this time.

WWQ]