April 2, 2003
Other Illnesses
Question from Long Prairie, Montana, USA:
Our 18 year old daughter, diagnosed with type�1 diabetes about a year ago and started on the insulin pump about seven months later, has recurring bouts of mono type symptoms during which she runs high blood sugar for days, misses school, and is unable to compete in sports.It appears as though she is not getting nutrition into her cells and thus, has a chronic hunger problem to the point of feeling physically full but still craving food/sugar and sometimes feels worse when taking insulin. She also has sugar in her urine whenever tested. At diagnosis, she was on Lantus (insulin glargine) with Humalog, and a few months later she was in a honeymoon at which time she took NovoLog only very sparingly. About a month later, she got ill again with what appeared to be mono like symptoms, went back on Lantus, and the NovoLog increased. Three months later, she went on the insulin pump (with Humalog) and is on an hourly basal rate that changes according to her need. Her current insulin/carb bolus is 1 unit insulin per 15 grams of carb, and she is taking 7.5 units per 24 hour period as basal. They tell us her pancreas still is producing insulin.
My daughter is is very athletic, and on days when she is feeling well, will run long distance, lift weights, etc, involved in three sports per school year and active in the summer months She has always been a positive, outgoing, child that is very athletic, but she has lost her strength and stamina, is situationally depressed when not feeling well, and has not yet made a full week of school since her initial diagnosis. She is a senior and off to college this Fall.
At the age of 13, my daughter had ovarian cysts, has never has had normal menstrual cycles, and she has been having hot flash type spells when not feeling well. We are wondering about the possibility of a pituitary tumor or hormonal imbalance. All blood work (for celiac disease, thyroid and Epstein-Barr virus) is normal or negative. We are at a loss of how to help her as is her treatment team (family physician, diabetes education team, endocrinologist). Any suggestions or directions as to what we should do?
Answer:
It sounds like a lot of options have already been investigated. Celiac disease sometimes can present like this. the best test is a transglutaminase antibody so please make sure that this is the test that was used. Addison’s disease as well as thyroid disease could also present in this fashion, and there are specific antibodies as well as hormone levels that could be checked.
The best thing to do is to go back to your daughter’s diabetes team and review all of what has been done and what else they are considering. It sounds like all the chronic viruses have also already been checked out and negative, but these could produce such prolonged symptoms. You did not mention the hemoglobin A1c levels or the type of blood glucose control being achieved. Anything that helps to bring these values closer to normal and without much wide day-to-day variations would help her feel better. Depression can present similarly, so talking to an experienced psychologist, social worker or other therapist may be helpful as well.
SB
