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December 11, 2007

Aches and Pains

Question from Fayetteville, Tennessee, USA:

My 13-year-old son was diagnosed with type one in September 2003. He has had stomach pains since then but, recently, things have been getting a lot worse. He has had four scopes done. Back in June 2007, they removed his gallbladder, thinking this was one of the problems since it was on functioning around 30%. The pain continued, getting worse. Then, in September 2007, they did a procedure called Nissen Fundoplication, which my son swears he would never have again. The doctors thought it was a really bad case of reflux, which is why this procedure was done. Now, almost three months later, my son is still in pain. His stomach hurts so bad at times that it brings him down to his knees. I am at a loss and don't know what else to do. Do you have any suggestions, reasoning for all of this discomfort? The doctor homebound my son from August 24 through November 26, 2007. He has returned to school, but things still are not any better. My son continues to have high blood sugar readings and spill urine ketones at least once every two weeks. In the past, my son has been tested for celiac and was negative

Answer:

This sounds very unusual, but impossible to diagnosis over the web. I assume that not only celiac but other inflammatory bowel disorders have been checked out and were negative, the same for thyroid and adrenal problems, acid reflux medications. There is a condition called gastroparesis where the gut motility is disturbed. It is rare in kids but not unknown. It is extremely difficult to treat and you may want to consider consultation with an adult gastroenterologist who also sees adults with difficult to control diabetes since they may have more experience than pediatric gastroenterologist. If this were the case, there are motility medications that may be tried. Also, one needs to be sure that this is not related to diabetes itself – i.e., omitted insulin would do the same thing and explain the high sugars and ketones. Direct supervision of all insulin administration and all blood glucose readings would solve this problem. Sometimes an insulin pump helps since it provides more physiologic insulin delivery and could even be programmed better/faster if the stomach/intestinal motility is severely disturbed. It may be wise to ask that the diabetes team and the gastroenterological team consult with each other and then have a joint meeting with your son and the rest of your family so that all questions can be asked and all options explored once again.

SB