My four year old son was diagnosed with type 1 just one week ago. My wife and I are having a very hard time understanding just what his risks of developing long term complications actually are. Our diabetes team tells us that if we keep good control over his glucose levels he has a very good chance of not having complications ever and, if he does, these complications will be caught early enough such that they can likely be treated. This conflicts with much of what we are reading, including last month’s JDRF Countdown magazine which has statistics that are quite scary. Can you help us understand the risks? Are there statistics available ?

There are thousands of research articles and review articles about the risks. I might suggest that, while this is a scary time so shortly after diagnosis, your immediate task should be to learn the basics of insulin kinetics, blood glucose monitoring, carbohydrate counting, sick day management, etc. with the help of your team. They are correct when they report to you that controlling the blood glucose levels is possible with our multiple dose insulin regimens and targeting blood glucose levels. If you are diligent in applying these principles, then you will be able to prevent or minimize the long term complications. The best data comes from The DCCT.

Insulin-Dependent Diabetes in Children, Adolescents and Adults by Ragnar Hanas, M.D. has excellent information about all these risks and what can be done to detect them early, start treatment early, etc. More importantly, controlling blood glucose levels for the years before the complications show up clinically is really the key to the success we had as investigators in the DCCT and that many of us have in our clinical practices on a day-to-day basis.

The information on the ADA and JDRF web sites are all correct. Remember that many people do not get educated well enough to provide optimum care of their diabetes; for many people these are difficult tasks. And, for much of the research being reported, they go back several decades when controlling blood glucose levels was less sophisticated than it is now. For fund-raising purposes, organizations like ADA and JDRF must walk a fine line between scaring everyone away, making people nihilistic about complications and the difficulties of day to day life having diabetes and simply minimizing such difficulties.

SB