Seven months ago, our three and a half year daughter was diagnosed with diabetes after being severely ill with an e-coli infection. She is currently on 1 unit of NPH in the morning and nothing else the rest of the day. Since her islet cell antibody test was negative, a doctor at the university suggested changing to an insulin stimulating oral drug, but her endocrinologist here said she is too young for the oral medications. Any suggestions?

I don’t really think you have given enough data to allow a definitive answer.

What are your daughter’s blood sugars? If she isn’t having any high blood sugars with normal kid diet and normal sugar challenges (cake, cookies, etc.), I wonder if she has diabetes.

Islet cell antibodies? There are other antibodies (such as anti-GAD and anti-insulin) in addition to the standard antibodies that might be checked. Several referral centers can do these tests. I think you should contact a referral center and ask which they have available. In a three year old, I think it is important to establish whether or not an autoimmune problem is present by doing proper tests at a center able to do the same.

If the premise is to control the glucose, an oral hypoglycemic agent might work even though none are approved for children as young as three. Like your local endocrinologist, I’m not sure I’d use them either, especially with as little information as you provide.

If the premise is to preserve the pancreas, then insulin is the only choice since the oral agents will stress the pancreas to work harder and cause more destruction if your daughter truly has type�1A diabetes. That is why the antibody testing is important to me.

The truth of the matter is any three year old can take 1 unit of NPH a day with little if any consequences. It shouldn’t make any child hypoglycemic.

LD