March 16, 2007
Insulin, Research: Causes and Prevention
Question from Grove City, Ohio, USA:
I have a couple of questions. The first question has to do with my daughter’s school. There are approximately 450 children in this school, six of whom have been diagnosed with diabetes. Five of them are in the same grade and I know that three of them were diagnosed within months of each other last year. I think this is very odd, but everyone I ask about this just sum it up to me being a distraught mother. I asked the ADA about it, but they danced around my question. I would just like to know about options I can take to gather more information.
The other question I have has to do with a recent episode that my daughter has gone through. She was diagnosed with type 1 on May 4, 2006. She is seven years old and weighs about 57 pounds. It didn’t seem as if her honeymoon period lasted very long, a few months. For the past five months, she has been receiving five units of Lantus and one unit of NovoLog for every 15 grams of carbohydrates. However, last Tuesday, she started running low. I had to reduce her Lantus to four units a day and, over the weekend, I did not have to cover her meals with NovoLog. Her blood glucose levels were in a good range, rarely over 130 mg/dl [7.2 mmol/L] even after eating. Now, she is getting one unit of NovoLog for 30 grams of carbohydrates. I guess I’m just confused since she has been on more insulin for five months and, in one day, her requirements changed. The doctor we see just called for her blood glucose levels and gave me instructions for the new ratio. I just wanted another opinion as to what is going on with my daughter. Her last doctor’s visit was February 14, 2007. At that visit, I was told her honeymoon period was over. Now, I am being told that it isn’t Could this go on for more than a year? Why did her set amount of insulin suddenly change?
Answer:
With respect to your first question, it is probably just an odd coincidence, although there clearly are environmental factors that precipitate the onset of diabetes in those genetically susceptible. We do not know very many of these, however, and unless there is a researcher looking at such questions, it is unlikely that one could sort this out. You may want to call the local health department of the county or state and see if you could find someone interested in such environmental factors. Your pediatric diabetes team may also be aware of someone interested in such research. Such research is expensive, must go on for many years of follow-up and is often done outside of the U.S. where there are centralized health services and computers that can track many individuals longitudinally. Pittsburgh has such a program in the U.S.
The second more specific question is unusual, but not impossible. Pancreatic function as it “dies out” does so often in spurts and this is likely what is occurring. Clinically, the advice that you have received seems correct since we always respond to the blood glucose levels and try to match the food and insulin accordingly. Honeymoon phases are not consistent and not often predictable except in large studies looking for group averages. For the individual child, it is very very variable. I have a patient six years old with an almost identical clinical picture seen today.
SB
