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Question:

From North Carolina, USA:

My 11 year old daughter was diagnosed one month ago with Type 1 diabetes. Just recently, the left calf part of her lType 1 diabetes. Just recently, the left calf part of her leg only started swelling and she complained it hurt to walk and was tender to touch. There is no sign of infection -- it is not warm to touch. Yesterday, both legs were swollen. Only the calf part of the leg is involved. No trauma to the legs, no cuts, no bruises, no muscle strain that we are aware of, etc.

She has seen an orthopedic doctor who is baffled and so is her pediatrician. The ortho doctor says he has never heard of clots in a child. Is that true? Could she be having circulation problems already? Should I forget these doctors and have her referred to a diabetic doctor? All of them say they are not familiar with diabetes so they are not sure what direction to take or what tests to perform.

Help! I am beside myself! She has a venous Doppler test for blood circulation scheduled for tomorrow morning. After that, the ortho doctor says if we get nothing from this, he's not sure what to do. Thank you so much for any information you can give me. She is also scared to death.

Answer:

It is highly unlikely that your 11 year old daughter has circulation problems from diabetes after only a few weeks. If the Doppler test is normal, you might want to consult a Pediatric Rheumatologist. I assume your daughter has had some simple screening tests such as a CBC (complete blood count), sedimentation rate, and chemistries including CPK. Very rarely patients with an overactive thyroid can have leg swelling, but usually on the front of the legs. I would suggest however, checking the thyroid function, if it hasn't been done yet.

Very rarely, people will transiently retain water and have swelling when high blood sugars are normalized with insulin therapy. This usually resolves spontaneously.

I feel that all growing children will benefit from the advice and experience of a pediatric endocrinologist. Your daughter's problem may not be directly related to her diabetes however.

Additional Comment by Dr. O'Brien:

As discussed by Dr. Lebinger, the issue might be salt retention, and hence edema, that is occasionally seen at the onset of diabetes. It resolves; but sometimes you can hurry this along with a mild diuretic.

DO'B

Original posting 3 May 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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