We are working with a family whose child was diagnosed with diabetes at the age of three months. Needless to say, he is quite unstable and the mother is checking blood sugars every four hours. Would you have any information on infantile diabetes? Is there a central clearinghouse, medical center that specializes, etc.?

Any information you are able to furnished would be greatly appreciated. We have explored our local children’s hospitals and understand that there are not many infants diagnosed. We are at a loss for ourselves as well as helping ability to help the parents.

At this point, it is not possible to determine whether this baby is going to have a form of diabetes that is transient or permanent. Evidence of autoimmunity, as shown by a positive antibody test, would favour the former as also would finding an abnormality in the long arm of chromosome 6 in the infant or the father. At the same time, it would be important to prepare for permanent diabetes. In these cases, there may also be a deficiency in what is called the exocrine pancreas (i.e., the part that provides digestive enzymes to the bowel). This needs to be explored if there is any evidence of nutritional deficiency.

The erratic blood sugars might be related to mismatches of shots of insulin a day compared to frequency of feeding. It might be worth discussing with the doctor whether it would be practical to give appropriately small doses of lispro with each feed, a step that might involve diluting the insulin even with the smallest syringe. Doing frequent blood sugars might be helped by using the FreeStyle meter which is painless and uses only a minute amount of blood.

Diabetes at this age is rare, one estimate was 1:400,000, but the principles of management are the same as for the older child, that is to keep blood sugars in the 80-180 mg/dl [4.5-10.0 mmol/L] range without episodes of hypoglycemia.

I have not been able to find any center in the U.S. that is particularly dedicated to the care and support of this group.

DOB

[Editor’s comment: It is unclear if this baby is under the care of a pediatric endocrinologist or not. If not, referral to such a specialist would be appropriate.

WWQ]