From Aiken, South Carolina, USA:
My nine year old daughter has had type 1 diabetes for eight months, and her last cholesterol levels were to be 203 and 204 mg/dl. She is very active, and I feel she eats a pretty good diet. We switched to non-hydrogenated margarine after the first test came back high but saw no change. Her father's side of the family has high cholesterol, so and I feel this is hereditary. Her doctor seems to have a wait and see approach to this.
I hate to see her on any more medication as she already needs allergy medication and Ritalin almost daily. Is this cholesterol level dangerous? Is it ever appropriate for children to take medication for high cholesterol?
I understand your concern. I have a couple of thoughts that I hope will reassure you.
First of all, it is not just the total amount of cholesterol that you should be aware of. There is so-called "good cholesterol" (formally referred to as "HDL-C") and so-called "bad cholesterol (formally referred to as LDL- C.") HDL-C is protective of heart disease; LDL-C is dangerous.
In adults, if the total cholesterol is 204 mg/dl, but the LDL-C is less than 130 mg/dl, you're in good shape, but your nine year old is not an adult so your point, and your doctor's point, is well taken. Anti-cholesterol medications have been used in children and they seemingly are as effective as in adults, but they have not yet had FDA approval (that is not the same as the FDA forbids or frowns upon their use; it means that no drug company has sponsored a trial in kids and submitted to the FDA to get the drug labeled as approved in children). However, we also do not have long-term effects for many of these drugs. Some of the older drugs that "bind up cholesterol" in the intestines, thus limiting absorption into the blood have been studied in children. A common one is cholestyramine which typically leads to changes in bowel habits. It is cheap, must be taken several times a day with meals, and doesn't taste good.However, hereditary plays a super-large role, as you know. Even under the most careful and optimal attention to diet and exercise, you might only expect cholesterol levels to decrease by 10-15%.
My final thought is that your child has only had diabetes a short time. Cholesterol levels do not change so rapidly. Some clinicians suggest only checking cholesterol profiles after five years of diabetes in pre-pubertal patients, and annually in pubertal patients. It is reasonable to know where you are starting out and getting a baseline sample, but get the entire profile to include HDL-C and LDL-C and the triglyceride (fat globules) measurement. Low thyroid levels can lead to higher cholesterol levels, and hypothyroidism is common in patients with type 1 diabetes, so it is reasonable to have thyroid levels checked if the cholesterol level is high. (Some say to check cholesterol profiles, thyroid levels, and urine microalbumin on that same five year or annual schedule that I mentioned above.)
So this is a long answer to say, that I agree with your doctor to take a cautious wait and see approach for now after confirming the cholesterol profile of HDL and LDL and the thyroid levels.
Original posting 16 Apr 2002
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:09:32
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