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 to 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 sugar 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 you should not try to obtain the best possible blood sugar control 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 control your blood sugar, 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 voiding serious low blood sugars. I do not believe we know what the mechanism is between hypoglycemia and neural dysfunction if it exists
- 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 blindness or kidney failure. No one went blind or developed kidney failure in either treatment group of the DCCT. 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, one would have seen a decrease in blindness and kidney failure 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, but it is important to try to treat your child as normally as possible and concentrate on enjoying life. Although it is upsetting to think of the possibility of severe complications in the future, 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 pumps, and before the DCCT, and are complication free.
- 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, but who decided to take each day one at a time, plan for the future, and lived long, productive lives.
- No one can predict which method presently under investigation will turn out to be successful either curing diabetes completely, preventing complications, or preventing diabetes altogether. 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 9 Mar 97
Last Updated: Tuesday April 06, 2010 15:08:54
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