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Question:

From Marietta, Georgia, USA:

My 14-year-old niece was diagnosed with diabetes a couple of years ago when she went into diabetic shock with blood sugar level of over 700 mg/dl [38.9 mmol/L]. Her diabetes is still not under control, even with insulin injections. She does not follow a diet and she does not exercise regularly. She has missed a lot of school. When I tell my brother that she has to watch her diet and exercise, he says that she takes insulin shots and that is all she needs. He said that she has a different kind of diabetes due to a virus that injured her pancreas. He says that her diabetes is not the same as others and doesn't have to be treated the same way. He seems to think that because her blood sugar levels are usually "around 300 mg/dl [16.7 mmol/L]," she is doing okay.

He says that he has spoken to another doctor who says that her current doctor is giving her the wrong type of insulin. He says that he will change her doctor. I'm really concerned that he has either been given wrong information or that he is misunderstanding what he has been told as I have never heard of this before. Meanwhile, I'm very concerned about my niece's health.

Answer:

Based on your letter, your brother is very, very misguided in his thinking.

There are 2 MAIN types of diabetes mellitus ("sugar diabetes," which is a very antiquated term): Type 1 diabetes and type 2 diabetes.

Type 2 diabetes is the kind of diabetes that USUALLY affects adults, who are usually heavy-ish and MAY NOT REQUIRE insulin. Lifestyle changes, including dietary monitoring and exercise are important to keep glucose controlled; medications, usually pills, are often required; insulin MAY be required, too, in some cases.

Type 1 diabetes USUALLY affects young people. They MUST receive insulin in order prevent the potential serious, life-threatening condition called diabetic ketoacidosis (DKA). But, diet and exercise are equally important. Insulin injections, while required to live, and to help with glucose control will not by themselves keep the glucose levels in the target range.

Glucoses of "300 mg/dl [16.7 mmol/L]" are definitely NOT the target range. Normal is about 60 mg/dl [3.3 mmol/L] to 100 mg/dl [5.6 mmol/L].

If your brother believes his daughter became diabetic because of "a virus", he, again, is (probably) mistaken. The science has evolved (over the past 20 years or so -- before your niece was born) that MOST cases of type 1 diabetes are caused by an autoimmune process whereby the body's own immune system produces antibody proteins which "attack" the pancreas's ability to make insulin. There are some cases of associated viral conditions with the pancreas, but, either way, the pancreas cannot make insulin well and supplemental insulin is REQUIRED.

Your letter suggests that your nice is NOT followed by a pediatric endocrinologist. There are several excellent pediatric endocrinologists in your state, several in the large, metropolis near where you live. Your niece may, in fact, be receiving a sub-optimal combination of insulins, but it sounds like much more needs to be addressed as well. I strongly urge you and your brother to have your daughter seen by a pediatric endocrinologist for sub-specialty opinion by a medical professional who works with young people (and their family) with diabetes and who may have a team to assist consisting of a nurse specialist or Certified Diabetes Educator, a Registered Dietitian, and perhaps a social worker or therapist.

DS

DTQ-20070426000134
Original posting 4 May 2007
Posted to Hyperglycemia and DKA and Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:10:12
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