From Indiana, USA:
My 4 year old son was recently diagnosed and I have been told that control of 200 or below is adequate to minimize microvascular complications. Is this appropriate? What is the mechanism behind the hypoglycemia and neural cell dysfunction? Do you feel that if I can keep his A1C levels at 6-8% that he will be able to maintain renal function into adult life? What are the stats for children and renal failure when the are diagnosed at this young of an age and are maintained within fairly tight control? I know that the DCCT is the main source of stats but I can't find anything to grasp onto to either minimize or validate my fears of the future for my son.
In addition to my previous questions, at what age or after what duration should I have microalbuminuria levels assessed? How optimistic can I be about the long term health of my child from a realistic perspective. I am very fearful of the complications but I am frustrated by the lack of hard information I've had access too which may indicate where I should place my energies. Do you believe that there may actually be a cure with beta cell transplantation within the next 10-20 years? What about the use of anti-oxidants early in the course of treatment in hopes of salvaging some of the beta cells?
I think you are correct in your assessment that there is little hard data regarding the chance of developing complications when diabetes develops at a young age. Any articles you may read about the incidence of complications after many years of diabetes cannot accurately be applied to children who develop diabetes in the 90's. You must keep in mind that the home use of blood glucose meters only became available to most patients in the mid 80's. Anyone who has had diabetes today for over 20 years, can not have used a meter initially and cannot have had as good control as you can get today (even if the control is not as good as you would like). In addition, many physicians honestly believed 20 years ago that it was not necessary to try to obtain as close to normal blood sugar control as possible and many patients were treated very "loosely" with only one injection a day and very little attempt at meal planning.
What can we say with reasonable certainty?
- The evidence seems very strong that the better you are able to keep your blood sugar in the normal range, the less chance of developing complications in the future.
- It is almost impossible to obtain "perfect control" with today's means of control.
- Some people's blood sugars are harder to control than other's with the same or more effort. We have no explanation why this is so.
- You should aim for as close to normal blood sugar as possible while avoiding serious low blood sugars. I do not believe we know what the mechanism is between hypoglycemia and neural dysfunction, if it exists (for more information refer to the previous question discussing this issue).
- You can't look to the DCCT study for the statistics you want. First of all, children under 13 did not participate in this study. Secondly, the study was not carried out long enough to give statistics regarding the development of blindness or kidney failure. No one went blind or developed kidney failure in either treatment group of the DCCT during the time of the study. The study was only carried out long enough to detect a difference in the rate of development of early complications. Although it seems reasonable to extrapolate that if the study had been carried out longer, a decrease in blindness and kidney failure would also have been demonstrated with improved control, the DCCT study did NOT actually prove this.
- Most importantly, I think it is important to try to remain optimistic and live life to the fullest. Of course as a parent, you will worry about complications in the future, but it is important to try to treat your child as normally as possible and concentrate on enjoying life. I think it is amazing how many people have lived full lives with diabetes for decades - before meters, before human insulin, before Humalog, before disposable syringes, before insulin pumps, and before the DCCT - and are complication free.
- It seems reasonable to anticipate that today with better means of control, children who develop diabetes will have an even better chance of not developing serious complications in the future.
- Forecast magazine (the ADA magazine for people with diabetes) is full of stories of people who were told decades ago not to plan careers or go to college as they would live shortened lives due to diabetes, but who fortunately ignored this advice, decided to take each day one at a time, planned for the future, and have lived long, healthy, productive lives.
- No one can predict which method presently under investigation will turn out to be successful either curing diabetes, preventing complications, or preventing diabetes altogether. In the meantime, people with diabetes and their families should try to enjoy life and take good care of themselves, so when these breakthroughs come through, they will be in good health physically and emotionally to benefit from them.
Original posting 18 Jan 97
Last Updated: Tuesday April 06, 2010 15:08:51
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