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From Mississippi, USA:

My daughter is 6 and has been diagnosed Type 1 since the age of three at the same time diagnosed with hypothyroidism. Is this normal? There is no history of diabetes in the family. Additionally, she still is not under control. Should I be concerned? She currently takes two shots a day of mixed insulins U, L, R and Humalog [Lispro insulin] if necessary (over 350).


Most new onset cases of Type 1 Diabetes do not have a history of the disorder in first degree relatives although the genes that convey susceptibility must have been carried by the parents. The basic disorder of the immune system, which primarily affects the beta cells of the islets in the pancreas - the insulin producing cells - may also involve other glandular tissues in the body. The longest recognised and most common of these is the thyroid In about 5% of cases there are also antibodies in the blood to an adrenal enzyme and this occasional results in adrenal gland failure. More rarely in about 1% of cases, other antibodies are also found which indicated a vulnerability to the celiac syndrome where there is difficulty in absorbing fat.

You did not say what standards you are setting for good control; but a conventional target to aim for at this age would be to keep fasting blood sugars between 85 and 180 mg/dl and to have the hemoglobin A1c stay at or below the upper limit of normal for the method used plus 10%.

Finally, in regard to the insulin dose. I interpreted your comments to mean that your daughter was getting two doses a day of a mixture of Ultralente and ordinary regular with occasional doses of lispro insulin [Humalog] when blood sugars were high. It is possible that the poor control is due to getting too much insulin with the attendant rebound (Somogyi effect). An average total dose would be around 0.8 Units/kilogram body weight/day and any dose above 1.0 Units/kg/day should make you wonder about this possibility. If your blood sugar meter has a memory, it would help to get it printed out to see if there is a discernable pattern to the blood sugars. You should also consider the possible effects of exercise and stress, especially at school. It might also make for a more even pattern of blood sugars if you changed to a mixture of N and lispro. The latter can be given immediately after a meal so that you can learn to adjust the dose to the before meal blood sugar and to appetite. The NPH might give you better coverage over the middle of the day.

It would be wise to discuss any proposed changes first with your daughter's pediatrician or pediatric endocrinologist.


Original posting 2 Dec 96


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Last Updated: Tuesday April 06, 2010 15:08:52
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