Our nine year old son, diagnosed with type 2 diabetes more than two years ago, is now taking Glucophage, and a month ago started taking GlucoRite. His glucose readings range 150-250 mg/dl [8.3-13.8mmol/L], which I do not consider good control. So, after consultation with our endocrinologist (who doesn’t deal with children with type 2 diabetes) and pediatrician, they prescribed Avandia and are saying that giving him insulin will be the last chance. While I agree with that as I am frightened about hypoglycemia. I have several questions:

Is he taking the maximum dose of Glucophage and GlucoRite or is he overdosed? I’m worried about him.
Is Avandia safe to be use in children? If yes, what is the dose for a nine year old child?
I’ve heard that when Avandia is taken with Glucophage, it has great results on glucose control. Is that right? What is the dose of each medication?

Please answer all of my questions as nobody in Gaza knows anything about type 2 in children, and I’m worried about my child.

You did not provide information as to how your son was diagnosed with type�2 diabetes and his presentation. I presume the diagnosis is correct. Although type 2 is being diagnosed more often in children, that diagnosis in a seven year old still makes me concerned about the accuracy of the diagnosis. Your physician hopefully will address that if you ask him/her. If they did not perform special blood tests to look for the various pancreatic antibody tests that are associated with type�1. diabetes, that might be reasonable.

GlucoRite appears to be a dietary supplement and not a pharmacologic agent [see below]. I do not believe that Avandia [rosiglitazone] is approved by the US Food and Drug Administration (FDA) for use in children. However, as has been explained on this website before, FDA “non-approval” is not the same as FDA “disapproval.” It really means that the FDA has not been provided with data from the manufacturer to show efficacy and safety. The available material from the maker of Avandia notes:

Pediatric Use: The safety and effectiveness of Avandia in pediatric patients have not been established. Avandia can be associated with liver problems, and it is recommended that blood tests on liver function be monitored.

Glucophage [metformin] has not been FDA approved in children under the age of 10 either, but pediatric practitioners use this medication. I know that I and my colleagues do, and on occasion, I have prescribed Avandia (rosiglitazone) and a similar drug called Actos [pioglitazone]. There are some specific precautions that your physician and pharmacist should talk about with you. The best doses of these medications are the doses that lead to proper glucose control that limits adverse effects. You did not give the weight of your child but the dose of 850 mg of Glucophage three times daily is very near maximum dosage and seems a lot for a “typical” young person with type 2 diabetes.

Your question indicated that your child is cared for by a general pediatrician. I don’t know your specific circumstances, but a visit with a pediatric endocrinologist at the various pediatric medical centers may well be very worth your while — not only to answer your questions, help confirm the diagnosis, but also to work with you and your child about meal planning, activities, and others.

DS

[Editor’s comment: See What You Need to Know about Type 2 Diabetes in Children.

SS]

[Editor’s comment: There are several websites that discuss GlucoRite. At least two state identical information as follows:

Normalizes blood sugar levels. It stimulates the production of insulin and minimizes its peripheral destruction.

Historically, this ancient formula has been used to help promote healthy blood sugar levels. It is good for abnormal blood sugar in chronic and preliminary stages.

INGREDIENTS: Aegle marmelos, eugenia jambolana, Curcuma longa, Tinospora cordifolia, Casearia es- culenta, Pterocarpus marsupium, Zingiber officinale, Piper nigrum, and Piper longum.

RECOMMENDED USAGE: Take 2 tablets two or three times daily as a dietary supplement before meals or as recommended by your Ayurvedic practitioner. For maximum benefit, continue using for at least 3 months.

WARNING: Not recommended for children and pregnant women.

I would wonder if it’s doing much to help blood glucose control, and when an herbal product clearly says it’s not for use in children, I would suggest that it not be used. Of course, if it is actually doing something to help, and you do stop it for safety reasons, there will have to be additional medication added as an alternative.

WWQ]