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Question:

From Cairo, Egypt:

My boyfriend has juvenile diabetes type 1. He recently proposed to me. I love him very much but I am really scared of the outcome of such a marriage. I have tried to check with so many doctors but opinions varied. Hence I would like to tell you the details of his case for advice.

He is a 29 year old Egyptian, who lives in Egypt. He got diabetes at the age of 15 years old all of a sudden. His parents discovered it because he used to drink a lot and pee a lot. None of his family had any diabetes whether from his dad's or mom's side. Not even to the second-degree relationship. Hence most probably a virus in the pancreas caused his diabetes, though we can never be sure about that. He has been under tight control keeping the sugar level between 100-200. He injects himself with insulin twice a day. Recently his doctor tried to give him a new medicine for type 2 diabetes to try to avoid insulin. Though he was not able to stop using insulin, his sugar level got more controlled with this medicine. He does not drink alcohol except rarely beer. He does not smoke either and keeps a very organized diet. He is not fat and well fit. He used to exercise until a year ago recently stopped. During his 14 years of diabetes he only forgot to take Insulin 3 times. He goes on regular checkups with his doctor. Checks his feet all the time. Has every 3-4 months eyes checkup.

There are 2 issues that concerns me:

  1. Heredity: I read through your questions that heredity is between 4-6% to the offspring when the father is the diabetic. Is it still heredity if he got the diabetes through a virus and not heredity?
  2. Complications:
    • What is the percentage of occurrence of complications under tight control?
    • What is the most common complication from the 3: eyes kidney and nerve?
    • If well monitored from the beginning can complications be cured or are they fatal?
    • I heard from a doctor that most of the juvenile diabetics get blind at the age of 40-50 years old: how far is this true? Please note that I have noticed that my boy friend has drops of tears in his eyes a lot. When I asked him about it he told me that he asked the doctor and told him that this is normal and could happen to anyone.
    • He also has allergies. Probably from the weather or the pollution. It makes him caught all the time and it gets worse when he sits in an area with smoke. Is this any sign of complications?
    • What are the other complications I should expect in our life? I heard that some diabetics lose patience by time and stop the treatment?
    • At what age should we expect complications to occur? Some people told me that after 30-35 years from getting the sickness that is why the earlier the person gets it the worse it is.

I am in a huge dilemma because I have consulted different doctors and surfed the Internet for different opinions and found a huge gap from go for the marriage no problem to the other extreme of avoid absolutely this marriage. Do you have any clue?

Answer:

I read across your letter with much attention many times before deciding how and what to answer the questions you addressed to our website. It's not easy to give you an answer through the Internet even though I believe that, from the 'diabetes' point of view, actually there shouldn't be any real obstacle towards a marriage with such a boy friend.

To summarize my points:

He's suffering quite probably from an autoimmune form of Type 1 diabetes (where viruses could either act as the initiators as well as the final triggers only upon an ongoing preclinical phase due to still unknown genetic/environmental interrelationships) that 90% of the times develops in people with no family history for the disease. The exact role of polygenetic set (in fact at least 14 genes are involved upon type 1 diabetes susceptibility and their number is expected to grow as gene mapping is being improved) towards type 1 diabetes haven't been defined yet even thus far it seems to sustain no more of 50% of the risk of the disease. The rest is environmental (diet, chemical, toxins, viruses, etc.) and the search is still underway. Then you can understand how difficult is to affirm that type 1 diabetes is simply due to an hypothetical virus or due to heredity: both environmental and genetic factors do play a still undefined and complex role.

Your boy friend seems to be managing his diabetes quite well as it can be judged from what you report in your letter. Does he check his HbA1c regularly and are its values fine? Complications are strictly linked to the average metabolic control, whose best index is HbA1c, as it has been shown by DCCT and UKPDS (The United Kingdom Prospective Diabetes Study). Generally speaking, one of the most positive finding nowadays is that on the average the incidence and prevalence of long term complications have declined steadily over the last decades among diabetic patients due to better management and care of diabetes itself and of blood pressure as well as of the other non-sugar-related risk factors (e.g., blood lipids). Based upon current intensified treatment schemes and HbA1c goals achieved, we are expecting a further continuous lowering rate of the incidence (risk) of diabetes complications in the future. Moreover, progression of already present long term complications has been deeply reduced if not halted by good metabolic control and new drugs such as ACE inhibitors. Furthermore, regular eyes checks and the use of laser therapy have reduced dramatically the sight threatening phases of diabetic eye diseases. Tears are not related to this anyway and I agree with your boy friend's doctor that it's normal and it could happen to anyone.

One shouldn't see diabetes as the cause of everything. For example, when you ask about allergy, there are two theories about allergy and type 1 diabetes. Most researchers say that both are more frequent in diabetic patients because the two diseases share the same autoimmune leading mechanism whilst some others quite recently have found that allergic disorders seem to be less frequent in diabetic patients because of the different immune path (Th1 vs Th2) towards the two. No relationship at all with diabetes complications.

Finally, what to say about losing of patience? Yes, it can happen as to everybody who carries the burden of a chronic disease but it implies the positive acceptance of the disease and the high risk period of the adolescence though. If your boy friend has passed through his adolescence without this sort of psychological consequences and has obtained a thorough knowledge of the disease and its treatment in order to perform the tasks required to safely achieve a good metabolic control, I think he will be able to manage properly any eventual period of refusal as well.

Now it's again up to you. If diabetes is not a problem anymore, then plan to enjoy your life together with your fiancee.

MS

DTQ-20000105090503A
Original posting 20 Mar 2000
Posted to Other

  
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Last Updated: Tuesday April 06, 2010 15:09:10
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