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Question:

From Bloomington, Indiana, USA:

My 13-year-old son has had type 1 diabetes for almost seven years. Twice in the last six months, the insurance company has called me to make sure that his endocrinologist is doing cholesterol checks. I explained that I don't think that it's a problem with 13-year-old diabetics, but they went into a long speech about heart problems with diabetics, most of which sounded to me like type 2. Can you advise me if this is really an issue for my son? I'm frustrated because they seem happy to pay someone to phone and ask what seems like a crazy question for a 13 year old, yet won't give him a device that could greatly help us monitor his health, a continuous monitor. We are in the process of getting a new pump as his old one is almost out of warranty, but they are refusing to pay for a CGM that goes along with it, which is quite disappointing to us as we are struggling with sugars as he goes through puberty.

Answer:

Routine assessment of lipid profiles is certainly important in ANY diabetic and perhaps that much more important (in my mind) with a person with type 1 diabetes - given the typical longer duration over a lifetime of diabetes. The lipids may not impact your son's heart today, but has implications over his life. Furthermore, other co-morbidities of type 1 diabetes, such as thyroid dysfunction, can impact lipid levels as well. Serum lipids should probably be checked annually starting in puberty.

For complete clarification, by "lipid profile" I mean not only checking cholesterol ("total cholesterol") but also the major subsets of cholesterol of "HDL-cholesterol" (so-called "good cholesterol") and "LDL-cholesterol" (so-called "bad cholesterol") and also the fatty droplets in blood called "triglycerides." While typically only triglycerides are best measured while fasting, the entire lipid profile is usually measured while fasting. Target goals for triglycerides and HDL and LDL cholesterols are based on other risk factors for atherosclerosis (other diseases, tobacco use, family history, and others).

As a clinician, I got rather incredulous that I would receive repeated mailings from patients' insurance companies reminding me to measure certain things (which I had already routinely measured and insurance companies paid). I suppose that general practitioners who don't follow diabetics warrant such reminders, but, to me, it is just a symptom of how our broken our health care system is and such mailings and phone calls contribute to excessive expense.

So, get your son's lipids checked, along with annual screens for thyroid disease and celiac disease, eye exams, urine tests and possibly tests for other conditions that have higher incidence with diabetes in general and type 1 specifically - as outlined by your pediatric endocrinologist. Keep fighting for the CGMS (but remember that it is only a tool to monitor - it will not take the place of some blood glucose testing).

DS

DTQ-20091202135915
Original posting 19 Jan 2010
Posted to Other and Continuous Sensing

  
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Last Updated: Tuesday April 06, 2010 15:10:20
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