Our family doctor recommended melatonin for some mild insomnia my 14-year-old son has been having lately. My son has had type 1 diabetes for nine years. He was diagnosed with ADHD when he was five and takes 60 mg of Strattera each day for that. The label on the melatonin says not for use in people with autoimmune diseases, diabetes and endocrine disorders. Reading up on it, I see that the worry is in boosting the immune system which can make some autoimmune diseases worse. I only plan to give it to him for a short time. His insomnia seems to have started at the beginning of lacrosse season, which is over in a few weeks. Is there a reason to be concerned about its use?

I performed a quick computerized review of medical resources keying in “melatonin and diabetes” and then “melatonin and type 1 diabetes”. There are some animal studies (mostly in mice and rats) investigating the relationship between melatonin and diabetes. Some studies involve animals prone to the equivalent of type 2 diabetes and some induced or prone to develop type 1 diabetes. There seems to be some relationship (NOT necessarily cause and effect) in some of the scientific studies that when insulin levels are low (as in type 1 diabetes), melatonin is high.

Interestingly, I found a study whereby, in a mouse model of type 1 diabetes, such mice that received transplanted pancreatic islet (insulin producing) cells had a prolongation of transplant survival when they received melatonin compared to such mice that did not receive the melatonin. This would suggest a positive impact of melatonin. How this might directly relate to a human – let alone a human with plain old type 1 diabetes without a transplant – is uncertain.

I found a review that analyzed other studies as to the potential beneficial effect upon the metabolic syndrome (a condition associated with “pre-diabetes” i.e., the propensity to develop type 2 diabetes) of various over-the-counter supplements, including melatonin. It appeared that melatonin may have some beneficial effects on cardiovascular effects. Another study showed that teens with type 1 diabetes have some beneficial lowering of blood pressure with melatonin.

All of these studies were within the last few years. I found no studies in this quick review that warned of adverse effects of melatonin in this population.

As a clinician, I think periodic use of melatonin to help with the sleep cycle in a child such as yours would have a good risk/benefit ratio. Still, you might want to look at the dosing and timing, etc. of the ADHD medications, to see if they can be modified to help his sleep cycle, especially psychostimulants and similar (I view Strattera as working similarly to that of classic psychostimulants).

DS