Question:
From Sheffield, UK:
Our five year old daughter has had insulin dependent diabetes for one
year. She is generally well controlled.
The problem is that she has had a couple of bouts of
distressing pains in her lower limbs, which she localises to her ankles.
They seem to be focused on the ankle joint area, but extend to around the
mid shin, and down to mid forefoot. This seems to come on when her sugar is
falling quickly, and possibly after she has been running higher than usual.
She also has hyperaesthesia at the same time. Our impression is that a
boost of short acting sugar stops the worst of the pain, which then
gradually wears off. This pain can come on when her sugar has dropped
fairly rapidly, e.g, from 14 to around 6 but it does not have to be low
enough to cause hypo problems. This has now happened several times, and is
very distressing for her and very difficult to handle for us.
Are we seeing something that is (a) anything to do with her diabetes; (b)
been described before; (c) actually to do with these sugar level drops, or
are we off target? We are worried and mystified.
Answer:
Pain is not a common symptom of low blood sugar, but low blood sugar can
cause any neurological symptom. If you feel that these symptoms are
associated with low or dropping blood sugar and disappear with treatment
of the low blood sugar, it is unlikely that your child has any other
problem. My advice would be to reassure your child that these pains are
not serious and to talk to you doctor about ways to try to avoid low
blood sugars or rapidly falling blood sugars. If the pains come
unrelated to low blood sugars, or if you child starts to limp or
develops swelling or redness of the joints, you should look for other
problems either unrelated to diabetes or problems more common in
children with diabetes such as juvenile rheumatoid arthritis. It is
highly unlikely that your child has developed neuropathy, a long term
complication of diabetes.
TGL
Original posting 20 Dec 97
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