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Question:

From Santa Barbara, California, USA:

Seven years ago, my son died from complications with initial onset of type 1 diabetes, and we have followed the research over the years because we have three other children. About 10 months prior to his diagnosis, he had an adenoidectomy for severely swollen glands, but the doctor did not remove the tonsils.Are there any statistics about the percentage of children with type 1 diabetes and having this procedure done prior to onset? My youngest daughter is five and seems very congested at night. I just wondered about this, in case her doctor were to recommends the same procedure.

Answer:

In your son's case, all the evidence is that the autoimmune process would have been established several years before the adenoidectomy and, that at most, the stress of the operation might have very slightly hastened the onset of insulin dependence. The chance of your five year old daughter developing type 1A diabetes too is only about 1:20; but I think you should talk to the doctor about getting an antibody test done and if this is negative, as I would expect, it would do a lot to relieve your anxiety should an adenoidectomy again be recommended.

DOB

Additional comments from Dr. Stuart Brink:

To the best of my knowledge, there is no association between tonsillectomy and adenoidectomy associated with the onset of type 1 diabetes.

SB

Additional comments from Dr. Larry Deeb:

I know of no literature on the subject. I also think it would be very difficult to perform such a study.

LD

Additional comments from Dr. Jim Lane:

I have never seen a statistic that examines the frequency of tonsillectomy prior to the diagnosis of diabetes. I am not sure I have seen any recommendations that suggest this commonly happens. It may be that upper respiratory infections may be more common when sugars rise and they interfere with the body's immune system. The result of this would be to have more frequent infections before diagnosis.

JTL

Additional comments from Dr. Tessa Lebinger:

I am very sorry to hear about your tragic loss. I am unaware of any such statistics relating prior adenoid or tonsil procedures to diabetes and doubt that any such statistics exist. I suspect your son's problems with his tonsils and adenoids were unrelated to his diabetes and would suggest you try to make the decision whether or not your daughter needs surgery based on her clinical condition now. I understand it is natural to worry about the tragedy that happened to your son, but doubt that this was related to his tonsil or adenoid problems.

Of course, diabetes can appear with the stress of surgery (or with the repeated stress of infection in an individual who needs surgery), but neither surgery nor repeated infections would cause diabetes in someone not destined to develop it anyway. They just might bring out the diabetes symptoms slightly earlier and more quickly (days, weeks, or maybe a few months earlier). If your child has any symptoms of diabetes, urinating excessively or drinking excessively, you should notify your doctor and have her checked.

I do not know exactly what happened to your son, but early diagnosis with avoidance of DKA [diabetic ketoacidosis] is the key to avoiding severe complications at diagnosis. You probably had no reason to suspect diabetes in your son and therefore probably were unable to diagnose his problem early enough to prevent ketoacidosis. A small percentage of individuals die with ketoacidosis even when properly treated. Since you are now painfully aware of the early symptoms, I am sure you would not miss the early symptoms in your daughter.

Remember also that her risk of developing diabetes is only 5-10% in her lifetime (or in another words she has a greater than 90% chance of never developing diabetes). I'm sure this is a difficult decision for you to make and brings back painful memories, but I hope that the right decision will become clear to you soon and your daughter will be well and you will find the emotional strength to enjoy her without constantly being pained by the tragic death of her brother (which I realize is very difficult).

TGL

DTQ-20030808165712
Original posting 11 Aug 2003
Posted to Research: Causes and Prevention

  
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Last Updated: Tuesday April 06, 2010 15:09:48
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