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Question:

My son was diagnosed with Type 1 a year ago. His control is good (A1C is 6.1%). He weighs 60 pounds and takes 1.5H and 13.5N in the A.M. and 1.25H and 1.5U in the P.M. His normal morning reading is around 90. He has been frequently complaining of stomachaches lately. I have two questions:

  1. Are these stomachaches anything I should worry about?
  2. Is the A.M./P.M. ratio of insulin normal? It seems he gets a lot more in the morning.

One more fact I should mention is that when he was diagnosed he did not show the HLA DR 3 or 4 gene nor did he show either the GAA or the ICA512 antibody.

Answer:

There are a great many causes of abdominal discomfort in children and without knowing much more about the history, whether there were any abnormal physical findings and the relationship of the pain to blood sugar and urine ketones, I would hesitate to make suggestions by e-mail. It is perhaps worth remembering, if there have been no positive findings to date that abdominal pain can be a reflection of psychosocial problems in this age group and it might be appropriate to ask for help from the social worker associated with the diabetes care team.

Your son's total dose of insulin, about 0.65units/Kg/day, is conventional at this time, albeit on the low side. Certainly the ratio of the morning to the evening dose is high; but it seems to be producing excellent control as judged by the A1c and the morning blood sugar. If there have been no hypoglycemic episodes I would not press to make changes for the time being.

The negative antibody test, I assume it was also negative for anti-insulin antibodies, and the absence of the DR3/DR4 pattern suggests that your son does not have Type 1A or typical autoimmune diabetes.

Recently it has come to be recognised that over half the new onset cases in Hispanic and African American children belong to this category and the same is true of about 10% of Caucasian children. This group is now sometimes referred to as antibody negative or Type 1B diabetes; but it would be wrong to suppose that the underlying pathology is uniform. A substantial proportion of the African American children with Type 1B have an abnormality on the long arm of chromosome 6. There are some other much rarer possibilities; but diagnosis is complex, expensive and hard to arrange, and in any case it does not affect treatment.

DO'B

Original posting 31 May 1998
Posted to Aches and Pains and Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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